WASHINGTON, D.C. – Today Congresswoman Lois Capps (D-Santa Barbara) and Congressman Deven Nunes (R-Visalia), called on the Centers for Medicare and Medicaid Services (CMS) to officially explain in writing the purpose, scope and duration of its so-called “pause” of the Recovery Audit Contractors (RAC) process in California by November 7th, 2007. 

“I am very concerned about the communication, or lack there of, from the Centers for Medicare and Medicaid Services (CMS) regarding this so-called “pause” in the Recovery Audit Contract program in California,” said Rep. Capps.  “A decision of this magnitude should be clearly communicated in writing to all stakeholders including Members of Congress and health care providers.  CMS’s unwillingness to respond to repeated requests for this crucial information demonstrates a severe lack of leadership and underscores the need for Congressional action to force CMS to address our concerns with this program.”

“I am very disappointed with the current situation.  If properly administered, the recovery audit process has the potential of being a very effective tool.  By their inaction, CMS is forcing Congress to consider legislative alternatives that may necessitate suspending the program entirely.  If CMS wishes to continue to have this auditing tool available, they should take immediate action to address our concerns,” said Rep. Nunes.”

In June of this year Congresswoman Capps and Congressman Nunes, along with 34 of their California colleagues, wrote to CMS regarding their concerns with aspects of the RAC program.  This letter was followed-up by a written response from CMS and a meeting with Members of Congress, their staff, and CMS officials on August 1st on Capitol Hill.  Following the meeting CMS promised to work with Members of Congress and health care providers to address their concerns with the RAC program. 

In September California health care providers informed Members of the California Congressional delegation that CMS was issuing a “pause” in the RAC process for inpatient rehabilitation claims.  Unfortunately, CMS did not directly inform Congress of this significant change in policy and has subsequently ignored repeated requests for the details of this new policy in writing.  Members of Congress remain concerned that the RAC program is too burdensome and unfairly penalizes health providers and their patients.  These Members are considering legislative alternatives to address these concerns, including introducing legislation that would put a moratorium on the RAC program nationwide.

A copy of the letter is attached: 

November 1, 2007

Mr. Kerry Weems
Acting Administrator
Centers for Medicare and Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244-1850

Dear Mr. Weems:

We are writing regarding communications we have had with CMS about the Recovery Audit Contract (RAC) demonstration process currently underway in California.  Earlier this year we, along with 34 of our California colleagues, wrote to CMS regarding troublesome aspects of the RAC process.  This letter was followed-up by a written response from your predecessor, Ms. Leslie Norwalk, and a meeting on August 1st here on Capitol Hill.

In September, we were informed by providers in California that there was going to be a “pause” in the RAC process as far as inpatient rehabilitation claims were concerned.  While we were disappointed that CMS did not notify us directly, we welcomed the news that CMS and the firm holding the RAC contract in California had come to this decision.

Our staff respectfully requested official notice in writing of the details of the “pause” so that we could provide accurate information to our constituents who are affected, but did not receive any.  Staff members in both of our offices received phone calls and emails from CMS officials stating that we would, in fact, receive something in writing.  These emails can be provided to you upon request.

It has now been over a month since we first learned of the “pause” and we have still not received anything in writing.  Furthermore, CMS officials indicated that the “pause” would last through October and we are unsure if or when the process will resume as normal.  As you can imagine, it is impossible for us to assist our constituents who are being affected without this information.

Therefore, we respectfully request that you provide us with information in writing no later than November 7, 2007 concerning:

The nature of the “pause;”
Until what date the “pause” will be in effect;
An evaluation of the “pause.”

If you have any further questions, please do not hesitate to contact our staff, Amy Fisher (Rep. Capps) at (202) 225-3601 or Andrew House (Rep. Nunes) at (202) 225-2523.

Sincerely,

LOIS CAPPS                                      DEVIN NUNES

Member of Congress                         Member of Congress

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Pictured above: (center) Congresswoman Capps meets with Central Coast firefighters to discuss emergency preparedness.