BALTIMORE--The Centers for Medicare and Medicaid Services' move to scrap its current Program Advisory and Oversight Committee, set up to advise the agency on competitive bidding, raises a slew of unanswered questions, some current members said last week.

On Oct. 1, CMS issued a call for nominees for a new PAOC, one day after sending current members a letter via FedEx notifying them of the change, according to Seth Johnson, vice president for government affairs for Pride Mobility Products in Exeter, Pa., and a current PAOC member. (See HomeCare Monday Special Alert, Oct. 1.)

Johnson said it was unclear why CMS would make such a change, particularly when a new administration, a new secretary of the Department of Health and Human Services and a new CMS administrator are on the horizon.

“The Medicare Improvements for Patients and Providers Act had language in it that extended the term of the PAOC two years,” Johnson said, referring to the legislation passed in July that delayed the competitive bidding project for 18 months. “But there was nothing in MIPPA that required or suggested that they terminate the PAOC and appoint new members.”

“Nobody knows why they did it. It's a mystery,” said Cara Bachenheimer, senior vice president of government relations for Elyria, Ohio-based Invacare, who has been a member since the committee's inception in 2004. She speculated that CMS might have made the move “so they can show they are actually doing something on the bidding program.”

As well, she said, “They seemed to imply they were going to give [us] a break.”

A provision in MIPPA extends the PAOC term from 2009 to Dec. 31, 2011, she said.

Whatever the rationale, she said, “I think it's a shame because the PAOC members spent a lot of time being up to speed on the most minute of details, and [CMS is] just throwing it away. I just don't understand what they want to accomplish.”

The PAOC was initially established in 2004 under the Medicare Modernization Act of 2003 to advise CMS on the design and implementation of the DMEPOS competitive bidding program. That board included home medical equipment providers, consultants, health care attorneys, manufacturers, supplier organizations and others.

Both Bachenheimer and Johnson pointed out that the CMS solicitation notice said the new PAOC would have 10 or 12 members, down from the current 21.

“They are reducing the size of the committee,” Johnson said, noting that just how those 10 or 12 spots will be allocated among beneficiaries, physicians, HME suppliers, professional standards organizations, financial standards specialists and association representatives is another unanswered question.

While Bachenheimer said she would likely apply for the new PAOC, Johnson said he would not. “It's my understanding they are looking for new individuals,” he said.

He added that he hoped the new PAOC would include representatives from the HME community who participated in round one of competitive bidding.

“I really hope that [CMS] receives a significant amount of nominations, especially from the provider community that participated in round one of competitive bidding, and especially those who were disqualified,” Johnson said. “Also from providers who went through the process and ultimately were not selected to participate in the program. They are the best ones to speak to what needs to happen to improve the overall process and the framework if it is to go forward.”

But the committee's makeup, he speculated, will likely depend “on what CMS feels it needs as far as advice to move forward with a modified form of competitive bidding.”

Whether the new PAOC will pack any punch is also up in the air. The current PAOC board members have been vocal in their criticism of CMS, saying that while the committee's name indicates they have oversight powers, they do not, and while they were to function as well in an advisory capacity, CMS seldom took their advice.

“I would certainly hope they would pay more attention to the PAOC,” Johnson said, adding that would be up to the new officials running the program.

Nominations for new PAOC members are due to CMS Nov. 3. For information, see the CMS Web site at www.cms.hhs.gov/center/dme.asp.