10/29/2020

NCART Update: CMS Issues Proposed Rule on DME Payment Rates

 

Late Tuesday, CMS issued Proposed Rule CMS-1738-P relating to a variety of DMEPOS payment rate and coding matters. The Fact Sheet from CMS can be viewed here. Below is an overview of the key takeaways:

• Manual CRT Wheelchairs- The proposed rule formally incorporates in statute the CRT legislation passed in December 2019 regarding CRT manual wheelchairs and accessories. This recognizes that CRT manual wheelchairs and accessories have a permanent exemption from any future Medicare Competitive Bidding Program (CBP). It also includes details regarding the 18-month suspension of CMS using CBP information to set payment rates for CRT manual wheelchair accessories (expires on June 30, 2021).  While it is good to see these items officially included in the CMS proposed rule, we need to continue to push CMS to "make permanent" the temporary CRT manual wheelchair accessory policy. 
   
• Payment Rates for DME Items- The proposed rule continues current relief for rural DME areas at the 50/50 blended rate while other non-bid areas will be paid at 100% of the adjusted fee schedule.  For DME items that were included in Round 2021 but which have essentially been removed, CMS states they are considering extending the current fee schedule adjustment rules "until new SPAs are calculated for the items once competitive bidding of the items has been resumed". 

• HCPCS Coding- The proposed rule includes changes designed to make coding applications, reviews, and modifications easier and more transparent. 

• Benefit Category and Payment Determinations for New DME-  With the intent of increasing inclusivity and transparency, CMS proposes a process that incorporates public consultation on benefit category determinations and payment determinations for new DME, prosthetics, orthotics, and other items and services under the Part B benefit.  

NCART will be conducting a more in-depth review and carrying out further analysis before submitting formal comments on these proposals by the late-December due date. 

CMS also made a major announcement regarding the Medicare DME Competitive Bidding Program (CPB). They will not be moving forward with implementing Competitive Bidding in 13 of the 15 product categories. The only two categories in which CPB contracts will be awarded and effective on January 1, 2021 are: (a) Off-The-Shelf Back Braces and (b) Off-The-Shelf Knee Braces. We expect that CMS will be issuing further details.