CMS Relaxes Timetable for CURES Changes

CMS has backed off from its Dec. 31, 2017 deadline and stated it will work with state Medicaid programs on their compliance, reimbursement plans.

After releasing its first CURES Act-related Medicaid update earlier in December, CMS has revised that guidance to state Medicaid directors when it comes to their approach for compliance so that it removes a difficult deadline and creates a more collaborative approach.

The original Dec. 27, 2017 letter said that state Medicaid programs had to notify CMS of their decision to submit an aggregate payment comparison, or an alternative approach to compliance by Dec. 31, 2017. Obviously, the guidance gave the state programs a very small window of opportunity to make a large decision — and then to reply.

The new guidance, issued Jan. 4, provides a much more flexible structure. Some key guidelines:

  • For state programs that chose to change their Medicaid state plan DME payment methodology to pay at or a lesser percentage of the Medicare rates for applicable DME items or by amending their state-developed fee schedules, they must submit a state plan amendment by March 31, 2018. with an effective date no later than Jan. 1, 2018.
  • For state programs that opt for an aggregate payment comparison, or an alternative approach to compliance, CMS says it will work with those programs to “determine the best approach to calculate the FFP limit for their state using expenditures for the period of Jan. 1, 2018 through Dec. 31, 2018."
  • CMS said once it obtains approval from the Office of Management and Budget (OMB) for the payment comparisons states will be required to submit that information. Then, the first comparative analysis must be submitted to CMS by March 31, 2019.
  • For subsequent years, states must notify CMS of any changes to their compliance method by Dec. 31 of that year. Their submitted demonstrations would be completed for the Jan. 1-through-Dec. 31 period of the following year, and submitted by March 31.
  • If the state discovers that its payments for DME items subject to statute exceed the FFP limit, it must return the overpayment to CMS.

When CMS issued the initial Dec. 27 guidance, the American Association for Homecare noted that it “quickly registered concerns with CMS” regarding that truncated timetable, and worked with the state Medicaid programs and various HME stakeholders to ask CMS to extend the deadline.

“We appreciate the quick response by our state and regional association partners in making their state Medicaid agency contacts aware of this issue,” said AAHomecare President and CEO Tom Ryan. “CMS also deserves credit for taking these concerns into consideration and issuing updated guidance. This change will allow states to make better informed decisions on how to allocate their resources and maintain access for Medicare beneficiaries who depend on home medical equipment and related services.”

Passed in December of 2016, the CURES Act included provisions to give relief to providers and patients affected by the national expansion of competitive bidding to non-bid areas. However, the Act also included an acceleration of the plan to limit the Federal matching on Medicaid reimbursement rates for HME to the Medicare fee-for-service payment rates, including for items impacted by competitive bidding-derived rates. Rather than apply those rates in January 2019, the application would be ramped up by one year to Jan. 1, 2018. 

AAHomecare noted that it will work with its members and the state and regional associations to help state Medicaid agencies implement the CURES-mandated reimbursement policies. It underscored that it will make sure that reimbursement adjustments are only applied to the 255 HCPCS codes targeted by the CURES Act, as well as lead efforts to roll back recent Medicare reimbursement cuts that are impacting reimbursement from various payers, including Medicaid MCOs.

“Now that reimbursement cuts based on competitive bidding-derived pricing are set to start impacting Medicaid beneficiaries, I believe many HME suppliers are going to struggle to serve this highly vulnerable patient population,” Ryan explained. "The home medical community needs relief soon — whether in the form of Congressional action or gaining the release of the HME-related Interim Final Rule now under consideration at OMB — or individuals and caregivers who rely on Medicaid are going to pay a steep price.” 

About the Author

David Kopf is the Executive Editor of HME Business and DME Pharmacy magazine. Follow him on Twitter at @postacutenews.


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