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, CAO Georgia Association of Medical Equipment Suppliers (GAMES) Spring Conference May 1 – 2, 2014, Savannah, GA

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. 2

The 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 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,

Competitive 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 5

The Competitive Bidding Program Today 6 Round One Round Two National Mail-Order Program Locations Currently Participating * American Samoa included but not depicted in graphic

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 7

Region 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 9 Diabetic Supplies 52.0% Oxygen Supplies 21.3% Wheelchairs 17.1% CPAP Devices & Supplies 16.8% Walkers 13.3%

Overview of CAO Functions R ESPOND C OMMUNICATE M ANAGE R ISK F ACILITATE 10

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, MEDICARE logged 105,555 inquirie s ₋61 complaints escalated from MEDICARE  Fourth Quarter 2013, CBIC received 1,889 inquiries with a majority related to policy and regulations 11

Click to edit Master title style Communicate: Partner Engagement Activating the “Ground Game” CMS provides resources and tools for beneficiary education Partners distribute Program information to beneficiaries Partners capture feedback from beneficiaries and provide to CMS 12

Communicate: Partner Engagement to Support Stakeholder Feedback CAO outreach meetings for 2012 and

Manage Risk: Issues Management Steps 14 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 IdentifyValidateEscalate Track to Resolution Communicate

Manage 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 better 15

Beneficiary 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. 16

CMS and CBIC Inquiry/Complaint Process 17

Click to edit Master title style CBIC Inquiry and Complaint Process Inquiries and complaints may be submitted to the CBIC by: – Calling – ing through “Contact Us” link on website – Mailing to: Palmetto GBA Competitive Bidding Implementation Contractor 2743 Perimeter Pkwy, Ste Augusta, GA CBIC Regional Liaison: – Areka Freeman Process for suppliers to submit inquiries and complaints:

Resources Competitive Bidding Program Implementation Contractor (CBIC) Website Competitive Acquisition Ombudsman (CAO) Website Payment/DMEPOSCompetitiveBid/Competitive_Acquisition_Ombudsman.html DMEPOS Competitive Bidding Educational Resources Payment/DMEPOSCompetitiveBid/Educational_Resources.html DMEPOS Partner Toolkit DMEPOS Competitive Bidding Program Monitoring Payment/DMEPOSCompetitiveBid/Monitoring.html State Health Insurance Assistance Program (SHIP) Medicare Supplier Directory (Supplier Locator Tool) 19 Medicare Call Center MEDICARE ( ) TTY

Contact the CAO 20 Tangita Daramola Competitive Acquisition Ombudsman Medicare Ombudsman Group, CMS CAO Website: Payment/DMEPOSCompetitiveBid/Competitive_Acquisition_ Ombudsman.html