Round 2: Bigger than expected?

Thursday, September 1, 2011

BALTIMORE - HME providers who don't think they're part of Round 2 may want to think again.

CMS on Aug. 19 released the affected zip codes for the 91 metropolitan statistical areas (MSAs) and it didn't take long for industry stakeholders to notice that the areas were bigger than expected. For example, they noticed the San Antonio MSA includes zip codes for Comal County, which includes New Braunfels, and part of Karnes County; and the San Francisco MSA includes zip codes for Marin County.

"They've added zip codes around the MSAs to bring in higher population areas," said Wayne Stanfield, president and CEO of NAIMES. "These are areas that wouldn't normally be included in the MSAs."

For Round 1, CMS released additional information about the nine MSAs in this order: maps of the affected counties, then zip codes.

Stakeholders believe CMS will release the maps at some point, but in the meantime, the agency is making it more difficult for providers to determine whether or not they're in an affected MSA.

"They're doing it in reverse this time," said Rob Brant, past president of AMEPA. "They're giving providers the zip codes, which forces them to scratch their heads and say, 'Where are these zip codes? What counties in the San Antonio MSA are included?' I think a lot of people are going to be caught off-guard."

To give providers a hand, AMEPA is putting together its own maps using the zip codes CMS has released, Brant said.

"Some of these areas have 300 or 400 zip codes in them," he said. "It's going to be very difficult to figure it out, especially for those companies that service people in outlier areas. They think, 'Oh, well, we're far enough from the center of the MSA; it won't affect us.'"

AMEPA will also use the maps to educate legislators who mistakenly believe Round 2 won't affect their constituents, Brant said.

"A legislator representing New Braunfels might say, 'We're not in the San Antonio MSA,' but they are," he said.

Nothing surprises industry stakeholders about competitive bidding anymore.

"From what we're hearing, there is some program creep here," said Walt Gorski, vice president of government affairs for AAHomecare.