Round 2019: 'Unfeasible if CMS sticks to business as usual'

WASHINGTON - It's becoming less and less likely that CMS will make its target implementation date for Round 2019, industry stakeholders say.

It has been a year since CMS put the brakes on Round 2019 of the competitive bidding program, and the agency still hasn't provided an update on its plans for the next bid round.

“If I were a betting person, I'd say it's certainly not going to happen on Jan. 1, 2019,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “At the end of the day, the Competitive Bidding and Implementation Contractor has a boatload of work to do, analyzing and vetting all of the bids.”

A week after CMS announced Round 2019 in February 2017, the agency said it would temporarily delay the program to give the new administration time to review it.

Since then, the Department of Health and Human Services has seen a shuffle in leadership, with Alex Azar taking the reins in January, replacing industry champion Tom Price, who resigned in September.

“There's been a lot of consternation with this program, so maybe Azar wanted to take a fresh look at things,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

CMS has typically given the bidding process—from bid window opening to contract implementation—about 16 months. With the current Round 1 2017, Round 2 re-compete, and national mail-order program for diabetes set to end on Dec. 31, 2018, stakeholders say CMS could extend the current contracts by six months to buy itself more time.

“With that timing, they have a similar timeline (as past rounds), if they came out with something by the end of March or even into April,” said Bachenheimer. “But it seems unfeasible if they stick to business as usual.”

AAHomecare and other industry stakeholders have continued to make recommendations to CMS and HHS officials on how to improve the program, such as making the online bidding process more efficient.

“We like to be optimistic, but it's impossible to say what's happening—or not happening—behind the scenes,” Bachenheimer said.

However, a recent proposal to expand the competitive bidding process to rural areas and to pay providers based on their own bid amounts, not the median bid amount, gives stakeholders a peak into the agency's thought process—and just how little it still seems to understand about the program.

“If they get rid of the median bid, would it be the bottom bid? Would you accept your own bid?” said John Gallagher, vice president of government relations for VGM. “How many bids would there be? It's a bit dumbfounding.”