Room at the Top: Who’s in Charge at CMS?

ATLANTA — President Obama’s failure to name an
administrator at the Centers for Medicare and Medicaid Services is proving
to be a stumbling block in resolving some critical home medical
equipment issues, stakeholders said last week.

Eight months after taking office, Obama still has not named a
permanent agency head — the acting administrator is CMS COO
Charlene Frizzera — and the White House remains
silent on both who and when it will do so. Any nominee for the job
must make it through confirmation hearings and be approved by the
Senate.

“I’m not hearing much of anything, which is a concern of mine,”
said Seth Johnson, vice president of government affairs for
Pride
Mobility Products, Exeter, Pa. “It’s now over eight months that
that position has been vacant, and there have been some rules and
regulations that have been rolled out that haven’t gone through the
significant analysis process that needs to take place.”

Johnson said the biggest HME issue so far has been CMS’ ramp-up
of its second attempt at national competitive bidding.
While the Department of Health and Human Services oversees CMS, he
noted, the Round 1 rebid was announced early this year, even before
Kansas Gov. Kathleen Sebelius had been named HHS secretary, and the
bid program is still being pushed forward without a CMS chief.

“Competitive bidding has largely been finalized,” Johnson said.
“The framework and the process and procedures are essentially the
same as we saw last year, which [was so flawed] it required
Congress to stop the process. I’m not sure how we are going to see
a different outcome when they are largely using the same rules as
before.

“I can’t figure out why the administration is continuing to
advance a lot of these controversial programs without leadership at
the top,” he added.

Don Clayback, executive director of NCART,
agreed.

“Without some leadership there, it’s more difficult for a new
perspective on some of the issues we have been trying to get
attention to,” he said, pointing not only to competitive bidding
regulations but also the creation of a distinct Medicare complex
rehab benefit.

“We are in the process of putting together our proposal [to do
that],” Clayback said, “and we’re not in a position to talk to them
now. But as we move forward, the head of CMS would be someone we
would like to educate and get their support for what our plan would
be.”

NCART has already taken the first steps toward devising that
plan. It has established a steering committee of stakeholders in
the complex rehab community and also has contracted with
Washington, D.C.-based consulting firm Avalere Health to conduct a
study on which route — regulatory, legislative or a
combination — would be best to push such a proposal forward.
(See NCART, NRRTS
Lobby for New Complex Rehab Benefit, April 28.)

After assessing the report, which is due in September and is
expected to cost up to $100,000, the steering committee will decide
on the best strategy, Clayback said. By that time, he hopes someone
will be at the CMS helm.

“As an industry, we are looking to competitive bidding
regulations and even just the policy-type decisions,” Clayback
said. “Not having someone in that spot is a hindrance. If you don’t
have a leader in place, it does compromise your efficiency and
effectiveness.”

The absence of a CMS chief is not playing well in Congress,
either, according to an Aug. 17 report in The New York
Times.

“It’s an extremely important position,” Sen. Ron Wyden, D-Ore.,
told the Times, “and it’s extremely important to have a
talented person in that post for health reform.” Wyden recently
circulated a letter to Senate colleagues asking that an “any
willing provider” provision be added to the competitive bidding
rules. (See Wyden:
Add ‘Any Willing Provider’, July 16.)

“It’s a big problem. I can’t explain it,” added Sen. John D.
Rockefeller IV, D-W.Va.

And as both houses of Congress try to hammer out a massive
health care reform package that cannot help but affect Medicare and
Medicaid, the problem is growing — for both HME and
Congress.

Any health care reform package is likely to contain provisions
that require regulations, Johnson said. “The biggest one right now
is the first-month purchase option for power wheelchairs,” he said,
noting that elimination of the option is included in the House
package and is rumored to be part of the Senate package as
well.

“Clearly, if they end up passing health care reform, it is going
to be even more critical to provide oversight of the bureaucrats
that are putting these rules and regulations together,” he
said.

Meanwhile, as Congress fights the health care reform battle, the
vacancy at CMS is a disadvantage, according to the Times
report.

“Trying to remake the health care system without a Medicare
administrator is like fighting a war without a general,” wrote
reporter Robert Pear.

Said Rockefeller to the Times, “You need a
general.”

Read the complete New York Times report.