CMS has some explaining to do


More than anything else, the binding bids language recently passed as part of the “doc fix” bill sends a strong message to CMS that its competitive bidding program, as currently structured, is majorly flawed.

Here’s why, unfortunately, it doesn't mean more: Per the bill, bindings bids will be applied for contracts “not earlier than Jan. 1, 2017, and not later than Jan. 1, 2019.”

As we’ve reported, this means the language has no impact on the Round 2 re-compete that’s scheduled to go into effect July 1, 2016, nor the application of bid pricing to all areas scheduled to go into effect Jan. 1, 2016.

That’s why, as AAHomecare’s Tom Ryan has said, getting binding bids language included in the “doc fix” bill was a huge victory, but not mission accomplished.

Ryan well knows, if nothing else changes, there’s a lot of pain, both for HME providers and Medicare beneficiaries, that’s going to happen before Jan. 1, 2017.

I don’t know the politics of why that date was chosen (it’s likely that modifying the Round 2 re-compete, a wheel already in motion, would have been too costly to pass muster with Congress), but it’s the reality of the situation.

There’s another reality, though: That CMS, which has had the luxury of largely ignoring the industry’s concerns, now has some explaining to do.

Namely: Why did the agency think it was OK to steamroll through two Round 1s, almost two Round 2s and a soon-to-be national roll out without binding bids, without state licensure requirements and other fixes to the program?

With binding bids language included in the “doc fix” bill, all of Congress, along with the president, are now watching.

What will CMS do next?

Will the agency work with industry stakeholders to do what’s right and implement binding bids and other fixes sooner rather than later, regardless of the dates and other specificities in the bill?

Or will it, once again, ignore the industry’s concerns until Congress, along with the president, forces its hands?

Either way, industry stakeholders are prepared. You see, they’ve learned a thing or two in the 10 or more years they’ve been battling competitive bidding.

Stakeholders are hoping to work with CMS, but because hope is not a strategy, they’re also drafting language and lining up champions to at least delay or phase-in the national roll out.

And this time, stakeholders have the momentum.