DMEPOS fee schedule for 2021, and analysis from the American Association for Homecare shows that CMS will continue applying CARES Act-related rates and that CMS applied adjustments to reflect consumer prices.
For starters, CMS will apply the CARES Act’s relief rates. Rural areas will still receive the blended 50 percent adjusted and 50 percent unadjusted rates. Non-rural areas will receive the 75 percent adjusted and 25 percent unadjusted rates.
As for competitive bidding areas, they will receive the current gap period rates that were established by Round One 2017 and Round Two Recompete competitive bidding rounds. (Readers might recall that CMS announced in late October that it would award contracts for only two categories — both over-the-shelf braces — and would not bid the 13 remaining categories, thus continuing the same rates that have been in place since the last contracts expired at the end of 2018.)
Also, per previous CMS announcements, the rates for CBAs will receive a Consumer Price Index (CPI-U) increase of 0.6 percent in 2021. AAHomecare reported that its analysis of the top 25 HCPCS codes for each region and CBAs confirms the adjustment was made.
“In our analysis we also found that the 2021 CARES Act relief rates in place for non-CBAs will see a slight decrease compared to the current relief rates in place,” AAHomecare added in its statement. “On average, rural areas will see about a 0.2 percent decrease and non-rural areas will see a 0.5 percent decrease.”
That said, AAHomecare reported that the new 2021 CARES Act relief rates in non-rural areas are “significantly” higher than what would have been in place if Congress had not expanded rate relief earlier this year.
“On average, the rates are 31 percent higher for January 2021 compared to January 2020 rates,” the association noted. “This significant relief has also broadly impacted other payers’ DMEPOS rates as many non-Medicare payers and state Medicaid programs base their rates off of the January 1st Medicare non-rural fee schedule each year.”
Links to AAHomecare’s region-by-region analysis:
- Far West – CA, OR, NV, WA
- Great Lakes – IL, IN, MI, OH, WI
- Mideast – DE, DC, MD, NJ, NY, PA
- New England – CT, ME, MA, NH, RI, VT
- Plains – IA, KS, MN, MO, NE, ND, SD
- Rocky Mountains – CO, ID, MT, UT, WY
- Southeast – AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV
- Southwest – AZ, NM, OK, TX
- Former CBAs
AAHomecare added it is still internally reviewing these rates and will work with state and regional associations to notify state Medicaid programs about the rates, as well as work to ensure they are applied to Medicare Advantage plans.