AAHomecare reported last week that CMS released updated guidance on a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) payment system that also includes major new provisions related to DMEPOS competitive bidding and the current fee schedule. According to CMS' Fact Sheet, provisions of the new rule include:
Bidding Program
- Beginning January 1, 2019 beneficiaries may receive DMEPOS items from any Medicare enrolled DMEPOS supplier until new contracts are awarded under the next round of the bidding program.
- CBA pricing will be subject to annual CPI adjustments until the next bidding round takes place.
- Implements lead item pricing for future competitive bidding rounds.
- Revises the definition of composite bid to mean the bid submitted by the supplier for the lead item in the product category.
- Establishes a new method for establishing SPAs under the CBP using maximum winning bids.
Rural/Non-CBA Reimbursement
- Extends the 50/50 blended rate reimbursement rates for rural and non-contiguous areas (i.e., Alaska & Hawaii) provided in the recent IFR through December 31, 2020.
- CMS requests additional comments on whether the 50/50 blended rates should be extended to other non-bid areas and will continue to monitor healthcare outcomes and information for future ratemaking.
Oxygen Reimbursement
- Establishes a new methodology for ensuring that all new payment classes for oxygen and oxygen equipment added since 2006 are budget neutral.
The CMS Fact Sheet does not set a specific timetable for the next bidding round.
"At first glance, CMS' new proposals look very promising," said Tom Ryan, president and CEO of the American Association for Homecare. "It looks like CMS has incorporated significant recommendations from HME stakeholders into the new rule, which should help improve the bidding program. While we look forward to doing a thorough analysis of the rule and sharing our findings with the HME community, it appears that CMS has taken an important step towards stabilizing reimbursement policy for our industry, setting the stage for us to advocate for additional reforms and relief going forward."
