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CMS finalizes reimbursement relief in rural areas

CMS finalizes reimbursement relief in rural areas It also addresses CGMs, infusion drugs, therapeutic shoes

WASHINGTON – CMS has published the DMEPOS Final Rule, making permanent the 50/50 blended reimbursement rates in rural areas but failing to provide relief in other areas. 

For contiguous, non-rural areas, CMS says it will be paying suppliers 100% of the adjusted fee schedule rates using information from the competitive bidding program. For former bid areas, it says it will be paying the single payment amounts established during the program, plus an inflation adjustment factor on an annual basis. CMS recently published fee schedule adjustments of +5% or more for DMEPOS for calendar year 2022. 

“The Council for Quality Respiratory Care appreciates that CMS has decided to prioritize beneficiary access to home respiratory supplies, equipment, and services in rural areas by making the “blended” rate permanent,” the council said in a statement. “This decision coupled with the removal of these devices from the competitive bidding program for Round 2021 have helped stabilize the Medicare home respiratory benefit at a time when these devices are an essential part of combating the COVID-19 pandemic and other acute and chronic respiratory diseases.” 

Stakeholders have been making the case to CMS that the 75/25 blended reimbursement rates in non-rural areas should be extended beyond the current public health emergency and that the single payment amounts in bid areas should be adjusted to reflect major changes in product and operational costs due to the pandemic. 

In October, stakeholders worked to get 95 members of Congress to sign a letter urging CMS to work with stakeholders to adjust rates to reflect the industry’s increased costs. 

“We’re pleased that the rule secures the 50/50 blend for suppliers in rural areas going forward, helping ensure access to DME in often-underserved communities and offsetting the higher costs of supporting patients over a wider geographical footprint,” said Tom Ryan, AAHomecare president & CEO. “What’s disappointing, however, is that CMS has missed another opportunity to take meaningful action on long out-of-date reimbursement rates for suppliers serving most of the nation’s population.”

Stakeholders plan to move forward with their champions in the House of Representatives, including Reps. Markwayne Mullin, R-Okla., and Paul Tonko, D-N.Y., to seek relief through legislation, according to VGM, including:

  • Extending 75/25 blend reimbursement at least through the next round of the bid program in 2023-24.
  • Extending 75/25 blended reimbursement to bid areas.
  • Modifying the bid program to reflect increased costs due to the pandemic, supply chain and other issues.

Other DME-related provisions in the rule: 

  • Technical changes to the regulations text to exclude infusion drugs from the bid program. 

  • Procedures for making benefit category determinations and payment determinations for new DMEPOS, therapeutic shoes and inserts, surgical dressings, or splints, casts, and other devices used for reductions of fractures and dislocations under Medicare Part B that permit public consultation through public meetings. 

  • The classification of adjunctive continuous glucose monitors (CGMs) under the Medicare Part B benefit for DME. However, CMS is not finalizing the proposed categories of supplies and accessories and fee schedule amounts for three types of CGM systems. 

  • CMS is not finalizing its proposals regarding (1) the submission and evaluation of HCPCS Level II code applications and (2) the proposed revision to our interpretation of the “appropriate for use in the home” requirement in the definition of DME as it applies to certain external infusion pumps. 

Go here for CMS’s fact sheet on the rule. 

Go here for the text of the rule.  


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