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05/03/2017

CMS Updates Reimbursement Adjustments for Rural/Non-bid Areas for July-December 2016

Source: 5/02/2017 AAHomecare Report

The Centers for Medicare & Medicaid Services has updated the fee schedule for rural and non-bid areas to adjust reimbursements to rural providers for products and services furnished between the July 1-Dec. 31 period.

As we first learned in February, CMS has utilized the July 1, 2016 adjusted fee schedule in recalculating the 50/50 blended fee schedules, which will result in rates that fall between the rates in effect on January 1, 2016 and the current rates in effect.  The example below for E1390 (oxygen) shows the difference in rates for January 2016 (50/50 blend with Round 2 info), newly updated July 2016 regional rates (50/50 blend utilizing the Round 2 ReCompete bidding round), and original July 2016 rate.

REGION

JANUARY 2016

ORIGINAL JULY 2016

UPDATED JULY 2016

% DIFFERENCE FROM ORIGINAL JULY RATES

% DIFFERENCE FROM JAN  2016 RATES

FAR WEST

$135.65

$74.40

$123.58

66.1%

-8.9%

GREAT LAKES

$135.41

$78.61

$125.82

60.1%

-7.1%

MIDEAST

$135.14

$75.75

$124.57

64.4%

-7.8%

NEW ENGLAND

$140.56

$77.72

$125.30

61.2%

-10.9%

PLAINS

$137.56

$81.46

$127.01

55.9%

-7.7%

ROCKY MOUNTAIN

$135.81

$78.97

$125.73

59.2%

-7.4%

SOUTHEAST

$137.50

$80.56

$126.67

57.2%

-7.9%

SOUTHWEST

$137.33

$78.75

$125.88

59.8%

-8.3%



"CMS' decision to recalculate these rates based on the July 1 fee schedule instead of the rates in effect on Jan. 1 are a slap in the face to both the home medical equipment community, as well as to members of Congress who worked hard to include relief for our industry into the CURES bill," said Tom Ryan, president and CEO of the American Association for Homecare.  "Individuals on Capitol Hill we've spoken with are perplexed that CMS has defied clear Congressional intent to essentially extend the Jan. 1 rates for the second half of 2016."

"While we're disappointed with this outcome, we're more determined than ever to advocate for better reimbursement policy for home medical equipment providers," Ryan added.  "This development lends additional urgency to our industry's efforts to provide longer term relief for rural and non-bid providers, and I expect these rates will help spur the HME community into heartfelt advocacy on this issue."  

You can find CMS' updated rates here (see DME 16C link).