CMS sets aggressive timeline for rolling out NCB program

Thursday, March 31, 2005

BALTIMORE — Industry leaders breathed a sigh of relief last month when CMS showed resolve in developing quality standards designed to prevent fly-by-night HMEs from participating in the 2007 competitive bidding program.
“If we don’t have standards, the bottom will fall out,” said Cara Bachenheimer, Invacare’s vice president of government relations. “You will have people who are not committed to the business come in and low ball, and that will drive the prices artificially low.”
Bachenheimer is one of 22 members of the Program Advisory Oversight Committee, which met with CMS officials Feb. 28 and March 1-2. Unlike previous meetings, PAOC members this time felt CMS officials had taken their concerns and comments to heart and had begun to develop a game plan to implement the mandated competitive bidding program.
“Previous meetings were very frustrating because it seemed like CMS realized that they had a huge amount of work to do but didn’t know where to start,” said one industry watcher.
At the most recent meeting, CMS and PAOC members addressed quality standards, how to structure the bidding process and how to ensure that small providers — not just large HMEs with economies of scale — are able to participate in the program.
At the moment, CMS has lots of questions and few answers.
Regarding small provider participation, CMS has to decide how to define a small company and whether it can: 1. bid as part of a network; 2. Subcontact out some of the bid work.
On conducting the program, CMS must decide how to solicit bids; how to determine a winner; and whether a provider must bid on all products or be able to pick and choose.
Proposed company standards drew heavily from current industry accrediting agencies and focused on eight topics: organizational structure; financial management; human resources; patient and client management; assessment and evaluation of quality standards; facility and patient environment and safety management; ethics and rights; and information management.
“It looks like they are on track,” said NCART executive director Sharon Hildebrandt on the standards. “It looks like they are hitting all the right spots in terms of what should be addressed.”
As far as implementing the bidding program, CMS has an aggressive time line. The agency wants to have a draft bidding plan developed by July 2005. That draft will address the provider application process and criteria for selecting products to be included in the bid. It also will address criteria for deciding where to roll out the program.
CMS will reconvene PAOC members this fall and solicit comments on the draft. Look for a final draft in early 2006, probably by March. During the balance of 2006, CMS will educate payers, providers and referral sources about competitive bidding; choose what products to include in the program; and decide where to roll it out. (CMS will debut the program in 10 of the largest metropolitan statistical areas.)
“I think this was the most substantive of the meetings,” said PAOC member Asela Cuervo. “At this point, we need to see what direction CMS plans to go in and we’ll know more detail on that when the rule gets published.”