Washington Wit & Wisdom
Dear Mr. President
To President Barack Obama, members of the United States Senate and the United States House of Representatives:
On Jan. 16, 2009, during the last few days of the Bush administration, the Centers for Medicare and Medicaid Services published in the Federal Register its interim final rule on the durable medical equipment competitive bidding program.
The rule was scheduled to take effect on Feb. 17, 2009, and is related to the July 15, 2008, enactment of the Medicare Improvements for Patients and Providers Act.
We are deeply concerned that CMS has rushed implementation of this rule counter to Congress' intent when it delayed the competitive bidding program as part of MIPPA. Congress delayed the bid program because it believed CMS' haste could lead to disastrous results for the 4 million beneficiaries impacted under Round One.
In particular, MIPPA specified certain reforms that must be achieved after receiving many examples of the serious problems the bid program would cause, particularly its restriction of beneficiaries' access to quality local providers and initiation of home care business closures or bankruptcies across the country.
In the initial implementation of competitive bidding, many questions were raised as to the immediate impact of the program on quality and access to care for patients. Of particular concern was the immediate elimination of thousands of eligible providers throughout the country from the Medicare program.
Of the more than 4,000 providers in the initial bidding areas, only 376 were deemed to have met the bidding program requirements, which were not clearly defined by CMS and its contractor. As growing numbers of seniors enter the Medicare program, it is important that we take care to maintain an adequate number of qualified and capable providers to address demand for care in the home, especially in rural areas.
In fact, we remain concerned that many of the recommended changes designed to prevent future access problems and confusion in the competitive bidding process were not incorporated or even raised for public comment.
