AAHomecare Submits Comments on DMEPOS Proposed Rule

Association suggested various alterations to the proposed rule released in November, including how rates for former CBAs and non-rural non-CBAs should be calculated.

The American Association for Homecare has submitted its comments for CMS’s DMEPOS proposed rule from early November.

The proposed rule can be downloaded as a PDF, and CMS has also provided a fact sheet, as well. The proposed rule contained many provisions, such as continuing  current relief for rural HME suppliers (50/50 blended rate) and excluding complex rehab manual wheelchairs, some additional manual wheelchairs, and certain manual wheelchair accessories from the bidding program.

In its comments letter to CMS on the proposed rule, AAHomecare included the following recommendations:

  1. Rates in former CBAs should be based on a 90-10 blended payment formula. The 90 percent should be based on the current payment rates in former CBAs, and the 10 percent should be based on the 2015 unadjusted fee schedule.
     
  2. Rates in non-rural, non-CBAs should be based on a 75-25 blended payment formula. The 75 percent portion should be based on the current rates in former CBAs, and the 25 percent portion of the blended payment formula should be based on the unadjusted fee schedule.
     
  3. CMS should eliminate its proposed limit on the number of times an applicant can re-submit applications for new or revised Level II HCPCS codes, as long as the applicant includes new data/information to support the request.
     
  4. CMS should add to its HCPCS code panel representatives from state Medicaid programs, and or a representative from the National Association of Medicaid Directors, and representatives of commercial payers. CMS should also rely on the outside clinical experts; for example, those it has established through MEDCAC.
     
  5. AAHomecare recommended that CMS incorporate into its HCPCS code application process a public notice and comment for its gap-filling and comparability analyses after a positive preliminary HCPCS code decision, to allow for both public input and for CMS to publicize the information it uses in making these payment determinations.
     
  6. CMS should permanently exempt accessories used with complex manual wheelchairs from competitive bid program-derived pricing, as it did in 2017 for accessories used with complex power wheelchairs.
     
  7. AAHomecare generally supported CMS’ proposal to expand coverage to adjunctive Continuous Glucose Monitors (CGMs), but urge the Agency to address a number of outstanding implications and allow for public comment on those issues.

CMS is accepting comments until January 4, 2021at https://beta.regulations.gov/document/CMS-2020-0128-0001.

AAHomecare noted in a statement that HME stakeholders are “welcome to support our comments and include it as an attachment to your comment submission.” To help them, it has provided downloads of its  full comments and our summary of the proposed rule, and

The associated added that it expects CMS will publish the final rule sometime after the transition of the new presidential administration.

About the Author

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

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