DME Rule Sent to OMB for Final Review

After a Congressional sign-on letter urged CMS and HHS leadership to release the pending DME rule, the agencies have moved the rule to the last stage of regulatory review.

CMS’s DME final payment rule has moved to the Office of Management and Budget (OMB) for review, which is the final, necessary stage in the regulatory review and approval process.

Proposed in 2020, the rule includes a number of top-level reimbursement items:

  • It would continue current relief for rural HME suppliers (50/50 blended rate).
  • Other non-bid area suppliers would be paid at 100 percent of the adjusted fee schedule.
  • Exclude complex rehab manual wheelchairs, some additional manual wheelchairs, and certain manual wheelchair accessories from the bidding program. (Of course, CMS officially stopped applying bid-derived pricing for accessories in a final rule released July of this year.)
  • Make changes related to the Healthcare Common Procedure Coding System (HCPCS) Level II Code Application Process.
  • Change the process for making Benefit Category Determinations and Payment Determinations for DME and other Items and services under Part B.
  • Change the classification and payment for Continuous Glucose Monitors under Part B.
  • Expand the classification of external infusion pumps as DME.

The news comes after 95 lawmakers from the House of Representatives signed a Congressional letter last week urging the leadership of CMS and HHS to finalize the DME rule.

That recognition by lawmakers of HME providers’ challenges and current day cost structures was thanks to HME stakeholders’ lobbying for signatures at the American Association for Homecare’s recent Virtual Washington Conference, says Tom Ryan, president and CEO of the association.

“Now that a significant segment of the House has taken an interest in the issue and gone on record that we need to take a look at rates, we have a good starting point in place if we need a legislative solution to address reimbursements,” Ryan said. “But first, we need OMB to move quickly to finish work on the Rule.”

The OMB's review and approval is required, but there is no deadline by which approval must be secured. If the OMB doesn’t move fast enough, AAHomecare will work with its champions in Congress to call for CMS to approve the rule.

 

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