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AAHomecare Provides Analysis on CMS' Recently Released DMEPOS Medicare Rule


"Breaking News" article below from AAHomecare published 12/23/21:

As we shared this past Tuesday, CMS posted the long anticipated DMEPOS Final Rule (CMS-1738-F). The rule puts into regulation the 50/50 blended rates in rural and non-contiguous areas that have been in place since July 2018. Although CMS believes the 50/50 blended rates are likely excessive, they are implementing them for the time being in light of previous comments from the DME industry. CMS estimates the 50/50 blended rates are 66% higher than the fully adjusted rates.
Although the DME industry advocated for permanent relief in non-rural areas, CMS is unfortunately maintaining the 100% adjusted rates after the end of the PHE. The final rule notes that prior to the PHE there were no access issues and assignment rates were 99%, which CMS indicates as rates being sufficient in the areas.
CMS states that they will be monitoring the payment rates in all areas and will likely revisit the fee schedule calculation to make changes in the future. CMS notes that the blended rates were intended to be transitional and were not meant to be permanent. 
Originally, the effective date of the fee schedule change was April 1, 2021 or immediately after the end of the PHE, whichever is later. But due to the prolonged PHE, CMS is making a technical change to make the effective date of the fee schedule provision to be the effective date of the final rule. AAHomecare anticipates the effective date to be on or around February 26, 2022. This will particularly impact the two product categories currently in CBP, OTS back and knee braces. Starting on the effective date of the final rule, the two product categories will receive the 50/50 blended rates in rural and non-contiguous areas, and 100% of the adjusted rates in non-rural areas. OTS back and knee braces will be not be receiving the CARES Act PHE rate relief. 
CMS finalized the decision to put the Benefit Category Determinations and Payment Determinations for DME and other items and services under Part B into regulation and to hold public meetings. However, CMS did not finalize the proposed changes to the to Healthcare Common Procedure Coding System (HCPCS) Level II code application process and will instead monitor and evaluate the process under the new more frequent application cycle. 
CMS finalized the classification of all CGM systems that use a receiver as routinely purchased DME. This includes CGM systems that are both adjunctive and non-adjunctive. However, CMS did not finalize the payment methodology for supplies and accessories used with CGMs. For supplies and accessories used with adjunctive CGMs, CMS will calculate the rates using the gap-filling methodology. 
Due to feedback from stakeholders, CMS is not finalizing the proposed expanded classification of external infusion pumps. CMS listened to the industry’s feedback that the proposal was unclear. 
You can find additional details in AAHomecare's summary of the final rule.  See also full text of the unpublished final rule. OAMES thanks AAHomecare for sharing this important and timely information.

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