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.
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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.
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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, 2014
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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
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The Competitive Bidding Program
Today
Locations Currently Participating
Round One
Round Two
National Mail-Order
Program
* American Samoa included but not depicted in graphic
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DMEPOS Competitive Bidding Program
Savings
• The Program has saved money for
beneficiaries and Medicare Feefor-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, 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
* “Hot spots” refer to CBAs in which ≥ 15 percent of all Medicare beneficiaries use DMEPOS
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Region 4 DMEPOS Use: The 5 Most
Commonly Used Items
52.0%
• Diabetic
Supplies
21.3%
• Oxygen Supplies
17.1%
16.8%
• Wheelchairs
• CPAP Devices & Supplies
13.3%
• Walkers
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Overview of CAO Functions
RESPOND
COMMUNICATE
MANAGE RISK
FACILITATE
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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 1-800MEDICARE
 Fourth Quarter 2013, CBIC received 1,889
inquiries with a majority related to policy
and regulations
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Communicate: Partner Engagement
Click
to
edit
Master
title
style
Activating the “Ground Game”
CMS provides
resources and
tools for
beneficiary
education
Partners
capture
feedback from
beneficiaries
and provide to
CMS
Partners
distribute
Program
information to
beneficiaries
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Communicate: Partner Engagement to
Support Stakeholder Feedback
CAO outreach meetings for 2012 and 2013
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Manage Risk: Issues
Management Steps
• 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
Identify
Validate
Escalate
Track to
Resolution
Communicate
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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
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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.
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CMS and CBIC
Inquiry/Complaint Process
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CBIC
Inquiry
andMaster
Complaint
Process
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to edit
title style
Process for suppliers to submit inquiries and complaints:
• 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.com
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Resources
Competitive Bidding Program Implementation Contractor (CBIC) Website
http://www.dmecompetitivebid.com
Medicare Call Center
1-800-MEDICARE
(1-800-633-4227)
TTY 1-877-486-2048
www.Medicare.gov
Competitive Acquisition Ombudsman (CAO) Website
http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/DMEPOSCompetitiveBid/Competitive_Acquisition_Ombudsman.html
DMEPOS Competitive Bidding Educational Resources
http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/DMEPOSCompetitiveBid/Educational_Resources.html
DMEPOS Partner Toolkit
http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/DMEPOS_Toolkit.html
DMEPOS Competitive Bidding Program Monitoring
http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/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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Contact the CAO
Tangita Daramola
Competitive Acquisition Ombudsman
Medicare Ombudsman Group, CMS
E-mail:
CompetitiveAcquisitionOmbudsman@cms.hhs.gov
CAO Website:
http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/DMEPOSCompetitiveBid/Competitive_Acquisition_
Ombudsman.html
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