BALTIMORE--In an Open Door Forum on Wednesday, CMS officials said once again that the final rule on DMEPOS national competitive bidding is on the way. But when it is issued, providers still will not get all the information they've been waiting on for months.

The agency has previously said that its final rule would contain the methodology for selecting the 10 metropolitan statistical areas where bidding will roll out, but that the names of the cities and the products selected for the bid would follow. The timing of that next communication and the form it might take has not been decided, according to Joel Kaiser of CMS' Center for Medicare Management.

"We have to wait for the final regulation to see what our final decision is on that ... We haven't determined exactly how we're going to be issuing the information on the areas and the product categories and the items under bidding, so just be patient a little longer and it will come," Kaiser said.

When an audience member at the Open Door session pointed out that "the lack of knowledge" about the cities is an issue, Kaiser reiterated, "Unfortunately, again, we have to wait for the rule."

Mandated by the Medicare Modernization Act to phase in NCB in 2007, it seems CMS may also be feeling the time pressure.

On Tuesday, the agency sent the rule to the Office of Management and Budget for a final regulatory review, estimating savings from the bidding program at $110 million the first year and more than $1.2 billion by the fourth year.

But CMS added this note for the OMB: "If this regulation is not published timely, we will be unable to meet the statutory implementation schedule and receive the anticipated savings."

According to the American Association for Homecare, once the rule is through OMB, it goes to the Government Printing Office to be published in the Federal Register. "Due to the short time frame CMS has to begin implementation of competitive bidding before the end of 2007," the association said, it expects that the rule "will be cleared by OMB quickly."

Even so, "CMS is really backing themselves into a corner now that they haven't released that final rule if they are going to be able to implement competitive bidding in 2007," said Seth Johnson, vice president of government affairs for Pride Mobility and a member of the Program Advisory and Oversight Committee, an industry panel formed to advise CMS on NCB.

According to Johnson, the PAOC was told by CMS that once the final rule is out, then the agency will follow with its Request for Bids, which will provide "details of what products will be chosen for what MSAs. But once the RFB documents are out," Johnson said, "we were told that it would be at minimum a 42-week process until implementation. And that's if everything goes smoothly and ... there are no hiccups in the process."

Assuming the rule comes out by April 1, Johnson continued, "42 weeks from then is early January, and we are no longer in 2007."

There are other indications that the agency is ramping up for publication of the rule. At the Open Door, Kaiser repeated the agency's admonition to providers to get accredited. "It is very important that suppliers begin that process now if they haven't already done so because there are a number of suppliers out there in those large MSAs, and they will need to be accredited for competitive bidding."

He also reminded providers to update their supplier information when enrolling with the National Supplier Clearinghouse, and noted that the Palmetto CBIC Web site will be up "in the near future." CMS has selected Palmetto GBA as its Competitive Bidding Implementation Contractor to process and evaluate bids, select Medicare's contract winners and set payment rates for bidding areas. (See HomeCare Monday, Oct. 16, 2006.)

To meet CMS' increasingly tight timeline on bidding implementation, some industry observers have said they expect a joint posting of some sort that would include the names of the cities chosen as bid areas at the same time the final rule is published.

Johnson noted, however, that CMS "has a lot of flexibility within the MMA statute as to how they roll it out, so in theory, CMS could, for example, implement bidding for some products in [one city in late December] and not implement it in the other nine until 2008 and still technically meet the statutory requirements of the law.

"Unfortunately, the longer they delay, the wilder and crazier it will get," he said.