BALTIMORE — After a delay because of "red flags" CMS said it discovered in a program integrity review, the agency appears closer to the announcement of Round 1 competitive bidding contract winners — maybe.
"CMS has not communicated anything to anybody, except by saying 'soon' when contracts will be announced. Maybe it will be tomorrow or maybe it will be two or three weeks," said Cara Bachenheimer, senior vice president of government relations for Elyria, Ohio-based Invacare Corp.
But there are some signs of activity. On Tuesday, the CBIC updated its website with a fact sheet on contract supplier obligations and information on subcontracting requirements along with several other documents. Yesterday, DME MAC National Government Services alerted providers in Jurisdiction B that CMS would hold two educational meetings in Ohio to discuss the bidding program.
Whenever the names are announced, Bachenheimer said, with just over 10 weeks until Round 1 is scheduled to begin Jan. 1 in nine MSAs, it will be a tight turnaround for providers to ramp up — or down — for the transition.
She pointed out that those who have not been awarded contracts but who might be able to continue working with Medicare beneficiaries under the grandfather rules have a deadline of their own. "Providers are required to give beneficiaries 30 days' notice if they are not going to continue," she said. That requires more than just a letter to beneficiaries because providers must coordinate with contract holders to ensure continuity of care.
"I'm not sure they [CMS] understand the practical impact of some of the decisions they make," added Miriam Lieber of Lieber Consulting in Sherman Oaks, Calif. "Providers need to get ready and, quite practically, the farther out you go, the more difficult it is to be ready.
"Providers are frustrated. They can't move forward," Lieber said.
The NGS notice said the educational meetings for providers/suppliers would be held on Oct. 27 in Cincinnati and on Nov. 3 in Beachwood, Ohio. "If you or somebody else in your office works with DME, please attend one of these important meetings that will answer your questions on the DMEPOS Competitive Bidding Program," the listserv message said.
"I would hope that the [contract suppliers] would be revealed by the time they do these education sessions," remarked Bachenheimer. "CMS is going to be really pressed to sufficiently educate in these nine areas."
Along with others in the industry, Lieber questions why CMS is holding back on revealing the names of the bid winners.
"We are running businesses where patients are on the line for this stuff. To compromise the integrity of businesses with patients who are sometimes in the last days … We need to get to the bottom of it and figure out what needs to be done," she said, adding, "It smells of something totally opportunistic on their part, and they really need to 'fess up. There is no way they shouldn't be prepared for something they have had all this time to do."
Stakeholders have wondered if CMS has run into difficulties getting enough providers to accept contracts (the agency has said that's not the case) or if officials are somehow reacting internally to the growing calls for a delay and redesign of the program.
In September, 166 economists sent comments to Congress in which they charged that the bidding program's design was fatally flawed, arguing that bids were not binding, the pricing rule was flawed, the use of composite bids promoted bid skewing and there was a lack of transparency.
CMS had reportedly been scheduled to meet with University of Maryland economics professor Peter Cramton, who initiated the letter, and White House economic advisors on Monday, but called the meeting off. There was no word when — or if — it would be rescheduled.
In addition, a lawsuit against the agency seeks revelation of the financial standards to which CMS is holding bidders, and H.R. 3790, which would repeal the program, has 257 cosponsors in the House of Representatives.
Still, CMS does not appear to be backing down from implementing competitive bidding — even though it could.
"There is nothing magical about Jan. 1," Bachenheimer said. "It is not in statute. That is CMS' deadline."
According to the Medicare Improvement for Patients and Providers Act, which in 2008 delayed the initial Round 1 of the bid program, CMS was only required to begin implementation of the Round 1 rebid in 2009, Bachenheimer said. Since that was when it opened bidding, "they are already meeting their statutory deadline," she explained.
Bachenheimer said she believes CMS does have the ability to delay the program's implementation.
"My interpretation is that they could delay it, but they are never going to. They are pretty committed to Jan. 1, regardless of when they announce the contractors."
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