CMS, PAOC Meet on Competitive Bidding
At a Special Open Door Forum on May 23, the Centers for Medicare & Medicaid Services (CMS) officials and Program Advisory and Oversight Committee (PAOC) members discussed key topics in the Notice of Proposed Rulemaking (NPRM) for competitive bidding published May 1. About 100 attendees joined members of the PAOC and CMS staff at the meeting in Baltimore, while many more listened in.
Included in the agenda was an update on quality standards and accreditation, and details on parts of the NPRM such as selection of the initial geographic areas for bidding in 2007, items subject to competitive bidding, payment rules, the bidding process and the request for bids (RFB) package.
Here are some highlights:
Quality Standards and Accreditation: CMS listed several key issues pulled from comments submitted on the draft quality standards last November. More than 5,600 stakeholders commented on the draft standards. The most common comment was that the standards were "too prescriptive." CMS officials said in the meeting that they agreed with this and are working to make the standards less so. Another common comment: Responding to a beneficiary call within 60 minutes is unrealistic. CMS said it was not their intent to suggest that providers had to arrive at a patient?s home within 60 minutes, and they agreed to clarify this or change the wording.
Regarding qualifications (licensure and credentialing) for staff and companies, CMS said it is taking comments into consideration from a number of accrediting bodies and others. CMS officials are also considering a number of comments on the business-standards portion of the draft quality standards document, including the general concern that they are overly burdensome and that some of the standards should be left to state and local laws. CMS also reported on beneficiary focus groups it held in which, according to CMS officials, many of the 44 "actively participating" beneficiaries viewed their home care provider as "no more than a delivery person." Many comments were made by attendees at the PAOC meeting who pointed out a number of flaws in the design and interpretation of these focus groups. The target date for CMS to release the final quality standards is June 2006.
CMS officials did not comment at this stage about several topics, including whether providers in MSAs selected for the first round of competitive bidding could be "grandfathered in" if already accredited. CMS said they would provide further guidance on this point and will announce the solicitation of accreditation organization applications after the final rule has been published. CMS said they would phase in the accreditation process and require accrediting organizations to prioritize their surveys to accredit providers in the initial Metropolitan Statistical Areas (MSAs) and competitive bidding areas. Officials said they "plan on having all competitive bidding awardees accredited prior to awarding contracts." But several attendees questioned how this is logistically feasible given the timeframe. In addition to accreditation concerns, attendees and members of the PAOC had a number of concerns about the bidding process and selection of winning bids, the selection of MSAs and administration of the program within an MSA, mail order issues, the development of provider networks and many others.
Rebates: The rebate provisions proposed in the NPRM prompted several PAOC members to express opposition to the idea, citing serious concerns about legal and administrative issues. Under the rebate program, providers who submit a bid below the single payment amount would be allowed to offer a rebate to beneficiaries equal to the difference between the provider?s actual bid and the single payment amount. CMS said the rebates would allow providers to be more competitive. PAOC member Dave Kazynski, president of VGM?s HOMELINK, commented that beneficiaries are chiefly concerned about quality, not a small rebate. And home care providers, he said, "are not looking at market share — they?re looking at survival."
Sustainability: Several PAOC members also said they are worried that unrealistically low bids would distort the process. Attorney Asela Cuervo, who represents AAHomecare on the PAOC, said, "There is no provision in the methodology to determine whether the winning amount is sustainable."
Submitting Comments about the Proposed Rule: Many more questions and concerns remain unanswered. It is critical for all home care stakeholders to submit their comments to CMS by the comment deadline of June 30, 2006. AAHomecare councils and committees have begun work on gathering comments for CMS and will share key concerns before the comment deadline. The AAHomecare Regulatory Committee met in Alexandria last week to outline key concerns about the proposed competitive bidding rule. The draft competitive bidding provider forms and other details are located on the CMS website, www.cms.hhs.gov, under PAOC Meetings, 5/22/2006-5/23/2006. The target date for CMS to release the final rule is Oct. 1, 2006.
To view the rule in the Federal Register, visit www.cms.hhs.gov/quarterlyproviderupdates/downloads/cms1270p.pdf
This article originally appeared in the May 2006 issue of HME Business.