In the waning hours of the Bush Administration, CMS has issued an interim final regulation regarding the re-rebid of round one of its national competitive bidding program for DMEPOS.
While the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 was able to secure a 18- to 24-month delay NCB, it did not repeal or change the nature of program. MIPPA required CMS to terminate the winning round one contracts from 2008 and essentially restart the program. This rule announcing round one will be re-bid is the first step in that process.
The rule goes into effect Feb. 15. CMS says that it has chosen to continue to apply the same methodologies of the program’s regulations, published in April, 2007, except for changes that were outlined per MIPPA. (To read the full text of the final rule, visit the Federal Register, or the AAHomecare site at.)
“It’s unfortunate that this rule is being released literally in the final hours of the Bush Administration,” said Tyler Wilson, president of the American Association for Homecare. “The fundamental problems associated with the bidding remain – this program will actually reduce competition, reduce access to care for seniors, reduce patient choice, reduce quality, and put good providers out of business,” he said.
Additionally CMS has provided a 60-day comment period that expires March 17. Providers can submit comments about the program as outlined in the final rule. AAHomecare has stated that the 60-day comment period does not provide enough time for public discussion, “given the magnitude of the program and the many patient access to care, choice of provider, and quality of care issues at stake.”
The round one re-bid will cover all the previous product categories from 2008, except for negative pressure wound therapy, and, per MIPPA, NCB no longer includes group three rehab power wheelchairs. In terms of MSAa affected, round one will include nine of its original competitive bidding areas, except for San Juan, Puerto Rico. The affected CBAs are:
• Cincinnati-Middletown, which affects parts of Ohio, Kentucky and Indiana.
• Cleveland-Eyria, Ohio.
• Charlotte-Gastonia-Concord, which affects North Carolina and parts of South Carolina.
• Dallas-Ft. Worth, Texas.
• Kansas City, Mo., and parts of Kansas.
• Miami-Ft. Lauderdale-Miami Beach, Fla.
• Orlando, Fla.
• Pittsburgh, Pa.
• Riverside-San Bernardino, Calif.
The rule also reinforces another important change concerning the notification of providers in regards to “missing” documentation. Last year’s bidding process with fraught with numerous cases of providers being told they had not won a contract because they failed to provide information — when many argued that they had indeed supplied the information in question. AAHomecare reported in April 2008 that it had received more than 100 complaints about the alleged errors that had nixed them from the process. Now, CMS says providers will be notified via a detailed process as outlined in MIPPA.
And, while CMS works to re-implement its NCB during the delay, the industry is continuing its efforts to change the program, end it, or replace it with something else.
A statement from the National Association of Independent Medical Equipment Suppliers
said that it “sees nothing in the rule that changes our ongoing plan to end
the competitive bidding program before it cost taxpayers any more in
increased healthcare costs and administrative costs by CMS. We intend
to work with Congress to introduce legislation to repeal competitive
bidding. We are also seeking information from the Obama administration
on their position on the program and the oxygen cap statute.”
“We will make the case to Congress that the bidding program is not a good option for home medical equipment and services,” said Michael Reinemer, Vice President, Communications and Policy for AAHomecare. “We will suggest alternatives to bidding so Medicare can ensure proper access to care for patients and fair treatment of homecare providers — who already provide the most cost-effective form of care in America.”