The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Competitive Bidding Program

The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Competitive Bidding Program

Introduction to the Competitive Acquisition Ombudsman (CAO) Role and Purpose

Presented by: Tangita Daramola, CAOGeorgia Association of Medical Equipment Suppliers (GAMES) Spring ConferenceMay 1 – 2, 2014, Savannah, GA

Introducing the Competitive Acquisition Ombudsman (CAO)

Introducing the Competitive Acquisition Ombudsman (CAO)

The role of the CAO is to serve as a neutral voice in responding to inquiries and complaints from suppliers and individuals regarding the DMEPOS Competitive Bidding Program, while also ensuring that Agency processes respond effectively to complaints about the Program.

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The CAO’s JurisdictionThe CAO’s Jurisdiction

• The CAO was established through legislation to support the Competitive Bidding Program by:–Responding to individual and supplier inquiries,

issues, and complaints.–Providing an annual report to Congress.• The CAO responds to inquiries and complaints

from anyone regarding the “application of the competitive acquisition program:”–“Application” relates to the implementation of

the program after awarding of contracts.3

Competitive Bidding Program To DateCompetitive Bidding Program To Date

• Round One – Program successfully implemented in

nine areas on January 1, 2011– By law, contracts must be

recompeted at least once every 3 years

• Round One Recompete– Competitive bidding program

supplier contracts in Round 1 areas ended December 31, 2013 (national mail order program remains in effect)

– Round One Recompete contracts went into effect on January 1, 2014

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Competitive Bidding Program To DateCompetitive Bidding Program To Date

• Round Two– Expanded to add 91 metropolitan statistical areas (MSAs)– Went into effect July 1, 2013– National Mail Order Program for diabetic testing supplies

implemented at the same time as Round Two• Includes all parts of the United States, including the 50 states,

the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa

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The Competitive Bidding Program Today

The Competitive Bidding Program Today

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Round One

Round Two

National Mail-Order Program

Locations Currently Participating

* American Samoa included but not depicted in graphic

DMEPOS Competitive Bidding Program Savings

DMEPOS Competitive Bidding Program Savings

• The Program has saved money for beneficiaries and Medicare Fee-for-Service Part B

• The program saved more than $400 million for beneficiaries and taxpayers in its first two years of operation

• CMS Office of the Actuary estimates the Program will save beneficiaries $17.9 billion over the next 10 years

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Region 4, Atlanta, DataRegion 4, Atlanta, Data

• Region 4, Atlanta, encompasses 25 CBAs– 18 percent of DMEPOS

users for Round Two are in Region 4

– Of the 25 CBAs , 21 are high utilization areas referred to as “Hot Spots”*

– Region 4 CBAs span across eight states

8* “Hot spots” refer to CBAs in which ≥ 15 percent of all Medicare beneficiaries use DMEPOS

Region 4 DMEPOS Use: The 5 Most Commonly Used Items

Region 4 DMEPOS Use: The 5 Most Commonly Used Items

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Overview of CAO FunctionsOverview of CAO Functions

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Respond and Monitor: Inquiries and Complaints Data

Respond and Monitor: Inquiries and Complaints Data

CAO responds to inquiries and complaints received through internal mailbox

CAO monitors inquiries and complaints from diverse inquiry and complaint systems

Fourth quarter 2013, 1-800-MEDICARE logged 105,555 inquiries ₋ 61 complaints escalated from 1-800-

MEDICARE Fourth Quarter 2013, CBIC received 1,889

inquiries with a majority related to policy and regulations

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Click to edit Master title styleCommunicate: Partner Engagement

Activating the “Ground Game”Communicate: Partner Engagement

Activating the “Ground Game”

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Communicate: Partner Engagement to Support Stakeholder Feedback

Communicate: Partner Engagement to Support Stakeholder Feedback

CAO outreach meetings for 2012 and 2013

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Manage Risk: Issues Management StepsManage Risk: Issues Management Steps

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• Identify potential issues• Validate issues through root cause analysis of patterns and

trends in data• Escalate issues to appropriate CMS components• Track to resolution and closure of an issue• Communicate issues and resolutions with internal and external

stakeholders

Manage Risk: Lessons LearnedManage Risk: Lessons Learned

• Regular collection and analysis of complaint and inquiry data provides:– Consistent, timely responses to inquiries and complaints– Timely identification of potential issues– Ability to quickly identify areas of potential improvement

• Listening to the concerns of beneficiary advocates and DMEPOS suppliers:– Ensures concerns are identified, understood, addressed, and

elevated to the appropriate Agency component • Continuous Agency engagement:

– Builds a communication bridge between the Agency and stakeholders

– Creates transparency in services and makes the Program better15

Beneficiary Rights and ProtectionsBeneficiary Rights and Protections

• All Medicare DMEPOS suppliers are required to be accredited and meet quality standards.

• The quality standards include key beneficiary protections and safeguards related to respiratory equipment, power mobility devices (PMDs), and other durable medical equipment (DME).

• All of these important protections and safeguards will continue to be enforced by independent accreditation organizations under the Program.

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CMS and CBIC Inquiry/Complaint Process

CMS and CBIC Inquiry/Complaint Process

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Click to edit Master title styleCBIC Inquiry and Complaint ProcessCBIC Inquiry and Complaint Process

• Inquiries and complaints may be submitted to the CBIC by: – Calling 877.577.5331– Emailing through “Contact Us” link on website– Mailing to: Palmetto GBA Competitive Bidding Implementation Contractor 2743 Perimeter Pkwy, Ste 200-400 Augusta, GA 30909-6499

• CBIC Regional Liaison:– Areka Freeman 803.648.9092

areka.freeman@palmettogba.com18

Process for suppliers to submit inquiries and complaints:

ResourcesResources

Competitive Bidding Program Implementation Contractor (CBIC) Websitehttp://www.dmecompetitivebid.com

Competitive Acquisition Ombudsman (CAO) Websitehttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid/

Competitive_Acquisition_Ombudsman.html

DMEPOS Competitive Bidding Educational Resourceshttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid/

Educational_Resources.html

DMEPOS Partner Toolkithttp://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/DMEPOS_Toolkit.html

DMEPOS Competitive Bidding Program Monitoringhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid/

Monitoring.html

State Health Insurance Assistance Program (SHIP) http://www.medicare.gov/contacts/search-results.aspx?customresult=AllSHIP

Medicare Supplier Directory (Supplier Locator Tool)http://www.medicare.gov/supplier

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Medicare Call Center1-800-MEDICARE (1-800-633-4227)

TTY 1-877-486-2048www.Medicare.gov

Contact the CAOContact the CAO

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Tangita DaramolaCompetitive Acquisition Ombudsman Medicare Ombudsman Group, CMS

E-mail:CompetitiveAcquisitionOmbudsman@cms.hhs.gov

CAO Website:http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid/Competitive_Acquisition_Ombudsman.html