The initial reaction to the Centers for Medicare & Medicaid Services’ (CMS) home health final rule, issued Nov. 28, reminded me of what happens when I stub a toe.
There’s a moment of shock, then recognition as my brain registers what just happened. It’s “Uh-oh,” followed by “This is going to hurt.” And finally, the pain comes rolling in.
This final rule’s timing (late in the afternoon on the day after Thanksgiving), and especially its length (762 pages) might have slightly slowed initial reactions, but the industry quickly chimed in. And since then, CMS has issued an update — clarification? — as well.
Here’s what we know so far about what the home health final rule said about the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) segment. For the latest from the American Association for Homecare (AAHomecare), register for a free update webinar, to be presented Monday, Dec. 15, from 2 p.m. to 3 p.m. Eastern time.
Early reports note significant changes
HME Business Executive Editor Bob Holly, likely stepping away from Thanksgiving pumpkin pie to provide breaking coverage on Nov. 28, noted that single-payment amounts for the next round of Medicare competitive bidding would be “calculated using the 75th percentile of winning bids, instead of the maximum winning bid,” according to the final rule.
Bob added that continuous glucose monitors (CGMs) and insulin infusion pumps “will be made on a continuous, monthly rental basis with payment for all necessary supplies and accessories included in the monthly rental rates beginning on the first day of the contract period,” as CGMs were confirmed as included in the next round of competitive bidding.
In a second story the same day, Bob reported that DMEPOS supplier accreditation would become an annual requirement, a major change from the current every-third-year cadence.
“The purpose of accreditation is to confirm that the supplier meets the DMEPOS quality standards,” CMS noted in its fact sheet on the 2026 final home health payment rule. “However, the CMS DMEPOS accreditation regulations have not been updated since their original promulgation in 2006, and we believe that program integrity vulnerabilities have risen substantially in the DMEPOS accreditation program over the years.”
Diving deeper into the final rule
Once the Thanksgiving holiday was officially over, industry responses to the final rule began to pour in.
One of the first official statements came from the American Association for Homecare (AAHomecare), whose President/CEO Tom Ryan described the final rule’s competitive bidding policies as regression rather than reform.
“The 2026 DMEPOS/home health final rule is a direct threat to patients and providers,” Ryan said. “By reviving the competitive bidding program without important guardrails established under the previous Trump administration and expanding the program to include diabetes equipment, as well as ostomy, urological and tracheostomy supplies, CMS is setting the stage for more stress on the home medical equipment sector.”
The Council for Quality Respiratory Care (CQRC) responded to oxygen being excluded from the next competitive bidding round, while the American Orthotic & Prosthetic Association (AOPA) expressed concern that off-the-shelf orthoses would be included.
Policy experts including Noel Neil, JM, CDME, chief compliance officer for ACU-Serve, pointed also to the Nov. 25 report from the Office of the Inspector General (OIG) that preceded the home health final rule by just a few days. The OIG report — Medicare Payments for Continuous Glucose Monitors and Supplies Exceeded Supplier Costs and Retail Market Prices, Indicating Medicare Can Save at Least Tens of Millions of Dollars in One Year — provided not-so-subtle foreshadowing of the inclusion of CGMs in the next competitive bidding round.
Cheryl Ory, president of United Ostomy Associations of America, said the organization “is deeply concerned” about including ostomy and urological supplies in the next bidding round. Ory described these supplies as “prosthetic devices and not one-size-fits-all medical equipment suitable for competitive bidding.”
Fact sheet changes
On Dec. 9, the industry got another update: CMS was excluding so-called “legacy” product categories — categories with a long history of being competitively bid — from the next round.
AAHomecare announced that oxygen, standard wheelchairs, CPAP systems and hospital beds, among other categories, had been left out, and that CMS had changed the fact sheet accordingly.
CMS also added, “All product categories for the next round will be included in the nationwide remote item delivery program.”
The first fortnight following the final rule has been full of surprises — and again demonstrated how many discussions continue even after a final rule is published. Industry organizations concerned about final rule provisions have vowed that those conversations will continue.
