AAHomecare, CMS Meet on Bidding, Reimbursement

Discussion between senior association staff and leaders at the agency indicates that CMS doesn’t look likely to start a new round of competitive bidding this year.

Senior staff from the American Association for Homecare met with CMS leaders last week to discuss DMEPOS reimbursement policy and the agency’s plans for future rounds of its competitive bidding program.

The meeting was held via Zoom, and Jason Bennett, acting director of CMS’s Technology, Coding and Pricing Group, led the CMS delegation.

“Our key takeaway from the meeting was the inference that CMS does not plan substantial rulemaking on HME this year that would set a new competitive bidding round in motion,” an AAHomecare statement read. “While the prospect of continuing open access to HME products in former CBAs should cheer suppliers, patients, and clinicians alike, reimbursement rates based on bids from seven years ago continue to hamper our industry.”

Bearing that in mind, AAHomecare underscored the need for adjustments to reimbursement rates that reflect the market realities that DMEMPOS suppliers are facing in the wake of both broad-based inflation, as well as increased product and operational costs.

To demonstrate that case, AAHomecare shared a timeline on former CBA reimbursement history and changing costs since the last completed and implemented bidding round in 2015. AAHomecare also advocated for extending the 75/25 blend for non-rural, non-CBA suppliers beyond the end of the PHE. 

Other discussion areas:

  • The association asked CMS to help ensure that audits on claims filed during the Covid-19 public health emergency do not trigger improper denials based on the wide range of waivers in place during that period. 
  • AAHomecare also requested CMS allow for patients that received a continuous glucose monitor during the PHE to continue to receive related supplies post-PHE, as many of the individuals who qualified under the waivers during the pandemic will not qualify when the PHE finally ends.

“Our CMS counterparts appear to understand and appreciate the challenges that the HME community is facing,” the AAHomecare statement read. “Even so, we must continue to engage Capitol Hill on our Medicare reimbursement priorities in the hopes of securing substantial relief at the legislative level, or to generate Congressional pressure on CMS on these issues.”

The associated said strong provider participation in its Sept. 21 Virtual Washington Legislative Conference will increase the industry’s chances of success on its agenda items.

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