I once naively thought that the bureaucrats at CMS were simply there to dispassionately execute the wishes of Congress. Pass the law and CMS will administer it, albeit with a fair amount of discretion. Members of my editorial advisory board, along with HME Today's faithful Our Turn columnists, would verbally smash CMS, and I couldn't help but think, isn't your gripe really with Congress?

My wall of naiveté has been chipping away for years now, and the last brick was swept aside when Herb Kuhn, deputy administrator of CMS, sent a letter to the Baltimore Sun lamenting the missed opportunity of competitive bidding. The letter went far beyond the sentiments of a mere policy wonk executing the will of legislators. Instead, Kuhn crossed into the role of advocate and wrote: "Congress just axed a promising program to replace government-mandated pricing with competitive bidding. So an oxygen concentrator that costs $600 to buy on the open market will continue, by law, to cost American taxpayers more than $7,000 to rent for 36 months for a Medicare beneficiary."

I remember a CMS official once used the line, "We are merely implementing the law," after a withering attack from a caller during an open-door forum. In fact, I heard this on a couple of occasions. Since then, I have come to realize that politics are at work. The Administrator is appointed, and ultimately he veers to the will of the executive who gave him his post.

Back in October 2005, several bricks in that wall of naiveté came down when Our Turn columnists David T. Williams and Cara Bachenheimer unleashed their judgment on the Program Advisory and Oversight Committee (PAOC). "To put it in simple terms—the industry has been duped," wrote Bachenheimer and Williams. "CMS entered its infamous 'listening sessions' with one goal in mind: reduce spending on HME and rehabilitation products. If allowed to proceed, CMS will make it virtually impossible for consumers to access the technology that trained medical professionals believe is most appropriate for their needs."

With the mess of competitive bidding only narrowly avoided for a time, the conclusion is obvious. CMS often has an agenda, and grassroots efforts are more important than ever. As Williams and Bachenheimer point out in this issue, it's time to build on the consumer group support that helped the industry gain its incredible legislative victory in the form of the competitive bidding delay. Specifically, they call for the industry to scratch the backs of consumer groups in the form of "full-throated support" for the Community Choice Act (CCA).

According to the advocacy group ADAPT (www.adapt.org), the CCA allows individuals eligible for nursing facility services, or intermediate care facility services for the mentally retarded (ICF-MR), the opportunity to choose community-based attendant services and supports—with the money essentially following the individual. While it may seem painful to spend money on other people's causes, the back we scratch today could help us in a big way tomorrow.

Greg Thompson