CMS CURES Guidance Raises Additional Concerns

Language of last week’s direction from CMS causes uncertainty over CMS's rate-setting methodology.

• By David Kopf
• Feb 16, 2017

After last week’s guidance from CMS on how the DME MACs should process the CURES Act reimbursement left many in the industry frustrated over a protracted timetable, the American Association for Homecare has uncovered another potential wrinkle in the directive.

The CURES Act requires CMS to extend the initial phase of partial reimbursement cuts to impacted items from ending on June 30, 2016 to ending on Dec. 31, 2016, and to retroactively reimburse claims filed between July 1, 2016 and Dec. 31, 2016.

However, CMS's guidance, which the agency released last week at http://bit.ly/2loPPZ8, won’t see the agency release a revised fee schedule to the DME MACs until at least May 1. Needless to say, this came as frustrating news to providers impacted by the national bid expansion, and particularly those in rural areas.

Now, AAHomecare is reporting that there are questions hovering over the exact rate-setting methodology CMS will be employing, thanks to the vague language CMS used in its guidance.

“To implement section 16007 for dates of service July 1, 2016 through December 31, 2016, the 50/50 blend fee schedules have been recalculated so that the adjusted portion of the payment blend utilizes July 1, 2016 adjusted fees,” CMS wrote in its guidance.

Without coming out and directly saying it, CMS’s language would appear to not follow the CURES Act, which calls for simply extending national bid expansion’s phase-in rate.

 

“For many home medical equipment companies faced with the unique challenges and costs of serving patients over widely-spread geographic areas, this adjustment schedule will further strain finances and potentially cause more suppliers to make difficult business choices or even shutter their operations,” a statement from AAHomecare read. “The uncertainty about how the rates will be recalculated is also an unwelcome development; in our opinion, applying rates in effect on June 30, 2016 for products and services delivered from July 1 through Dec. 31, 2016 is the common-sense reading of the intent of the CURES bill.”

 

AAHomecare noted that it has contacted CMS asking for clarification on how the reimbursements will be calculated.

“We remain committed to a longer-term solution to deliver sustainable reimbursement rates for rural and non-bid area providers,” the association noted in its statement. “We hope to build relationships with new leadership at HHS and CMS that will result in a better appreciation for the regulatory challenges our industry faces and lead to action to reduce these burdens to the benefit of patients and suppliers alike.”