CMS Releases Proposed DMEPOS Payment Rule

Proposed rule covers various provisions, including continuing rural relief and removing manual CRT wheelchairs and accessories from bidding. Public comments will be due Jan. 3.

• By David Kopf
• Oct 28, 2020

In tandem with CMS’s somewhat surprising Round 2021 announcement, the agency also released its proposed rule on Medicare DMEPOS payment policy.

CMS’s will officially publish the 210-page proposed rule in the Federal Register on Nov. 4, but it can be downloaded as a PDF, and CMS has also provided a fact sheet, as well.

Industry advocates and regulatory experts are currently analyzing the specifics of the proposed rule’s many provisions, but an American Association for Homecare update outlined some known top-level items:

• It continues current relief for rural HME suppliers (50/50 blended rate). Other non-bid area suppliers will be paid at 100 percent of the adjusted fee schedule.
• It excludes complex rehab manual wheelchairs, some additional manual wheelchairs, and certain manual wheelchair accessories from the bidding program.
• It makes changes related to the Healthcare Common Procedure Coding System (HCPCS) Level II Code Application Process.
• It includes changes to the process for making Benefit Category Determinations and Payment Determinations for DME and other Items and services under Part B.
• It makes changes to the classification and payment for Continuous Glucose Monitors under Part B.
• It expands the classification of external infusion pumps as DME.

Also, CMS might extend the transition payment rules that have been in effect in former competitive bid areas during 2019 and 2020 for items falling under the 13 product categories that CMS removed from Round 2021.

Comments on the proposed rule will be due Jan. 3, 2021, 60 days after the Nov. 4 publication date.