With CMS' recent announcement of the next 70 MSAs for competitive bidding in 2009, this frightening new program will impact approximately three quarters of the beneficiary population requiring HME. More importantly, the program will now be relevant to a significant number of Members of Congress who previously had the luxury of having their constituents sit on the sidelines and simply be able to watch the first 10 areas go live.

Two thirds of the United States Senators represent states that will be affected with this program in 2008 and/or 2009. Our job now is to make sure that these Senators and Reps care about the impact this program will have on their collective constituents: consumers, providers, small businesses, and others.

While the traditional election year trend is for Congress to do relatively little, this year will be somewhat different. Again, Congress is faced with the expiration (on June 30, 2008) of the so-called "doc fix," the measure Congress passed late in 2007 to ensure that physicians did not receive a 10% Medicare payment cut in January 2008. Since Congress was able to pay for only a 6-month "fix," it is now faced with the question of whether it has the political will to extend that fix before it expires, or let it languish (in an election year). In addition, the House and Senate Democratic leadership views last year's Medicare packages (which did not get passed or signed into law) largely as unfinished business and a logical starting point for a Medicare package early in 2008.

With these facts, our mandate is clear. We need to make competitive bidding a relevant issue that Congress pays attention to and is willing to do something about. With 435 Representatives and 35 Senate seats up for reelection, there are a lot of politicians looking for voter approval this year.

The federal budget cycle begins with the President's February 4 submission of the Administration's proposed budget to Congress. Like last year, the Democratic-controlled Congress will declare the Republican Administration's proposed budget "dead on arrival," and Congress will begin its budget process in March by establishing House and Senate Budget Resolutions, which will set broad parameters for Congress this year. As part of this process, Congress will move forward with the development of budget and Medicare packages. What will eventually pass into law is impossible to predict, but there will be much activity on Medicare issues. The one thing that is certain in an election year is that Congress will adjourn early, in October, providing Members time to return home for last minute campaign activities before the November elections.

In July 2008, the first 10 competitive bidding areas will go live. That means beneficiaries in these 10 areas will be faced with the possibility of having to switch providers, and moving to a winner who may or may not provide the same level of equipment and service. It remains to be seen what the level of disruption will be in these 10 areas, but we surmise it will be significant because consumers have not been aware of CMS' implementation of this new program. Any kind of change can be daunting to consumers.

Over the summer, CMS will be starting the request for bids process in the 70 new metropolitan areas. It remains to be seen whether CMS' upgraded system will be able to accommodate the increase in bid submissions, and whether CMS and its contractor will be able to handle the increased provider inquiries that inevitably will occur. And we know there will be many other hiccups, if not deep potholes, for providers and consumers as CMS proceeds.

In the fall, likely in September or October, suppliers will have to begin notifying beneficiaries of the impact of the Deficit Reduction Act's 36-month cap. Suppliers have no obligation to continue serving beneficiaries once the 36-month cap occurs, nor do they have any obligation to continue delivery of tanks, or to perform maintenance and service. All of this is clear under CMS' regulation issued in November 2006. If suppliers choose not to continue serving oxygen beneficiaries once they have reached the 36-month cap, CMS requires suppliers to notify beneficiaries at least 2 months prior to the cap. However, you can and should notify beneficiaries earlier.

The convergence of all these events means that the noise level from consumers (and providers) is likely to elevate to unprecedented levels. The combination of multiple policy changes taking place at the same time can only cause confusion with consumers. Our mission is to work closely with these consumers, help them craft the important message to Congress, and make sure that Congress understands the real impacts of these policies on consumers in their districts and states.

Cara C. Bachenheimer, JD, is VP of government relations for Invacare Corp. David T. Williams is a political and legislative strategy consultant.