CMS Issues NCB Final Rule

BALTIMORE — Years of conjecture and mounting anxiety about the final rule for national competitive bidding ended on April 2 when the Centers for Medicare and Medicaid Services unveiled the document, then opened official registration for bidding on April 9, then set Aug. 31 as the accreditation deadline for first-round bidders.

Mandated by the Medicare Modernization Act of 2003, the bid project will replace the current Medicare fee schedule for some DMEPOS with a single-payment amount. Leslie V. Norwalk, CMS acting administrator, said that when fully implemented in 2010, the program would save taxpayers $1 billion annually.

“Given the need to tackle the continued and unsustainable growth in health care costs, this new program represents yet another way to use the competitive marketplace to bring the best possible and most efficient care to Medicare beneficiaries,” Norwalk said at a press briefing.

She said the request for bids was expected to be issued at the end of April (although at press time the RFB had not come) with a bid window of 60 days for providers in the 10 MSAs where bidding will begin.

Published in the April 10 Federal Register, the long-awaited rule generated shock and surprise among industry stakeholders. Some pointed to litigation and/or legislation as possible shelters from its stipulations.

“This has got to give us a tremendous amount of ammunition for the Tanner-Hobson bill because there is not a lot of good that will come out of it,” said Cara Bachenheimer, vice president of government relations at Elyria, Ohio-based Invacare.

She referred to H.R.1845, the Medicare Durable Medical Equipment Access Act of 2007, introduced in March by U.S. Rep. John Tanner, D-Tenn., and co-sponsored by Reps. David Hobson, R-Ohio, and Mike Ross, D-Ark. (the only HME owner in Congress). The bill would ensure accessibility for beneficiaries and soften some of competitive bidding's effects by allowing any qualified provider who had submitted a bid below the current allowable to continue doing Medicare business.

Tyler Wilson, president of the American Association for Homecare, pledged the association “will aggressively enlist cosponsors” for the proposed legislation. “This bill would fix some of the larger flaws in the competitive bidding program,” he said.

Meanwhile, VGM Group general counsel Jim Walsh said Last Chance for Patient Choice, an advocacy organization backed by the Waterloo, Iowa-based buying group, plans to file lawsuits in Texas and Ohio challenging the implementation of NCB.