Home Health & Hospice Week

Suppliers pull out all the stops to get the program delayed.

Both suppliers and the feds are working furiously in anticipation of the July 1 implementation of competitive bidding for durable medical equipment, but who will win out is still a big question mark.

DME suppliers want to see competitive bidding, which is set to take effect in 10 metro areas next month, delayed or canceled altogether. But the Centers for Medicare & Medicaid Services is dead set on implementing the program next month as planned.

"The dire prediction of NAIMES and other industry advocates are coming true everyday as implementation comes closer," warns the National Association of Independent Medical Equipment Suppliers in a message to members.

Now the American Association for Homecare has filed suit to stop the program. The suit filed June 9 in Washington, DC federal court cites faulty implementation as the reason for an injunction halting the program, according to an AAHomecare release. "Regulatory implementation of the bidding program has resulted in numerous violations of the Medicare Prescription Drug, Improvement, and Modernization Action of 2003 (MMA), the Small Business Act, and the Administrative Procedures Act," the trade group says.

The federal lawsuit names Department of Health and Human Services Secretary Micheal Leavitt and CMS Acting Administrator Kerry Weems as defendants.

Meanwhile, work on the political side isn't slowing down either. Various lawmakers have been calling for a bidding delay for some time. Now a letter from 132 members of the House has asked the House Ways and Means Committee and its health subcommittee to delay bidding before it's too late.

"It is of the utmost importance that we protect access to quality medical supplies for all of our seniors," says the letter authored by Reps. John Tanner (D-TN), David Hobson (R-OH) and Jason Altmire (D-PA). "We urge that the implementation of Round 1 be delayed for at least a year."

Forty senators signed on to a similar June 10 letter to Senate leaders, including Finance Chair Max Baucus (D-MT), AAHomecare reports.

And the chair of the House Small Business Committee, Rep. Nydia Velazquez (D-NY) also sent a letter to the Health subcommittee urging a delay. "CMS has failed to address a number of shortcomings in the bidding process," the letter says.

"While we continue a full-court press on the legislative front to delay the bidding program, we also want to get the courts involved in reviewing this troubled program," notes AAHomecare's Tyler Wilson in a release. "The bidding program will put thousands of home care providers out of business, and patients' access to quality home medical equipment and services will suffer as a result."

Holding its ground: But CMS Acting Administrator Kerry Weems is fighting back with statements to the press.

A delay would mean "at least another year in which Medicare beneficiaries and American taxpayers are overcharged, by an average of 26 percent, for durable Medicare equipment" and "at least another year in which our beneficiaries will not have the assurance of accredited and financially sound suppliers providing this vital equipment and these services," Weems told the Congressional Quarterly Healthbeat newspaper.

"In government, sometimes it's just hard to have losers," Weems told the Associated Press. "And I think that's the pressure being applied here."

Take action: Industry trade groups urge suppliers to contact their representatives on the matter as the deadline draws near.

Even winning suppliers should realize that have a lot at stake, NAIMES urges. The new claims processing manual chapter on bidding "exposes glaring draconian regulations that should make every supplier who signed a bidding contract seriously reconsider their decision," the trade group insists. "Never in the history of service to a government program has there been such a lopsided relationship between supplier and payor."

Your Bene Letters Are Late

Meanwhile, CMS is issuing a flurry of documents in advance of the July 1 deadline. New tip sheets for grandfathered suppliers, referral agents, non-contract suppliers and diabetic mail-order suppliers are available on CMS' revamped bidding web site at www.cms.hhs.gov/DMEPOSCompetitiveBid --click on the Provider Educational Products and Resources tab and scroll down to the "Downloads" section for the sheets.

Several of the tip sheets urge suppliers to issue their beneficiary notices of bidding by June 1, meaning suppliers are already behind schedule if they haven't done so. The notices should tell benes whether the supplier is choosing to grandfather allowed items like oxygen.

CMS also has issued a MLN Matters article noting that marketing requirements for suppliers under bidding are the same as those for all Medicare suppliers. For example, unsolicited calls to beneficiaries are not allowed except under tight exceptions.

Clarification: Competitive Bidding Implementation Contractor Palmetto GBA accidentally included mail order area ZIP codes with regular bidding ZIP codes, making some suppliers fear that the initial bidding areas had grown, reports AAHomecare. CMS is working to clarify the issue.

"We are ... extremely concerned that suppliers may have incorrectly notified patients that they must now find a new supplier," says AAHomecare's Walter Gorski in a release. "This is just another example of the hasty rush to implement the program rather than ensure that it is done in a proper manner."

Next up: CMS has scheduled a Program Advisory and Oversight Committee meeting on bidding for June 16. DME MAC National Government Services has planned two Ask-the-Con-tractor teleconferences on bidding for July 1.

Note: The MLN Matters marketing article is online at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0820.pdf.