--Beneficiary Outreach: What has been done and what is allowed?

Several callers expressed confusion over the proper procedures for beneficiary outreach. One caller asked whether current Medicare rules governing the methods of direct contact between a provider and a beneficiary still apply under competitive bidding.

“My related question is that now that these contracts are announced, are the winning bidders free to advertise and communicate with the marketplace subject to those preapproval rules?” he asked, noting that some of his customers had been contacted by contract winners and told they would have to change providers because his company had not won a contract.

A CMS official responded, “We are not establishing special marketing guidelines for contract suppliers under this program. All of the current DMEPOS supplier guidelines that apply as far as marketing continue to apply. For example, the current prohibitions on cold-calling Medicare beneficiaries when there is no prior history of service and also prohibition against misusing the word Medicare and Medicare symbols continue to apply.”

Another caller asked what CMS has been doing to ensure beneficiaries are ready for round one.

“What type of communication is going out to the beneficiaries directly? The thousands of patients that are on service right now today--how are we communicating with them? Who is going to help them in transitioning if a supplier is not going to grandfather? Who is taking the lead on helping that patient that's laying in their bed, unable to get the mail or anything?” the caller asked.

The response: “We don't have representatives here from the communications staff … but [we're] using every avenue we can. We have organizations of the state health insurance programs who are helping to reach beneficiaries. There is going to be a mailing to beneficiaries in bid areas. [We have an] extensive network of advocates for beneficiaries who are going to be helping us with education.”

The caller pressed, “Who is helping the patients who don't go out of their homes? Who don't go to meetings? I just don't understand how CMS is going to reach those patients to tell them what is going on.”

The response: “We don't have the beneficiary outreach people here so it's hard to give you, really, specifics. We'll try to have someone here next time.”

During the conference call, agency representatives referenced two tip sheets--one on grandfathering and another for referral agents--that would be posted to the CMS Web site. They also said providers should notify beneficiaries of their decision on grandfathering by June 1.

“According to the teleconference," said Toscano, "a non-contracted supplier that elects not to become a grandfathered supplier must provide notification to the beneficiary. So they are asking in the next 30 days [that providers] notify every single rental patient that has a piece of rental equipment. If the patient chooses to switch, the supplier must pick up the equipment.

“We're supposed to notify each beneficiary, get the letters back and arrange for pickup if necessary and tell them to visit the Web site or make the phone call all within the next 30 days. I think that's an undue burden on a lot of suppliers, especially if they have thousands of rental patients,” Toscano continued, adding she believes that “no beneficiary education has been done [by CMS] to date.

“They promised intensive outreach and education. None to our knowledge has been provided,” she said.

For more on the agency's new tip sheets, see "CMS Issues Tip Sheets for Grandfathering, Referral Agents" in this issue.

To hear a complete replay of the CMS teleconference, which will be available through June 4, call 800/642-1687 and enter access code 47261135.