December 22, 2021

CRT Advocates and Stakeholders,

Late yesterday CMS released the long-awaited Medicare DMEPOS Final Rule (CMS-1738-F, CMS-1687-F, and CMS-5531-F). You can read the Final Rule here and reference the Fact Sheet here.

The final rule includes provisions regarding the application of Medicare Competitive Bidding Program (CBP) payment rates that will go into effect at the end of the COVID-19 Public Health Emergency (PHE):

  • For rural and non-contiguous areas, CMS will continue paying suppliers the 50/50 blend of adjusted and unadjusted fee schedule rates.
  • For contiguous, non-rural areas, CMS will be begin paying suppliers at 100 percent of the CBP adjusted fee schedule rates.
  • For the former Competitive Bid Areas (CBAs), CMS will begin paying the single payment amounts (SPAs) established during the DMEPOS CBP updated by an inflation adjustment factor on an annual basis.

While the final rule makes permanent the 50/50 blended rate for rural and non-contiguous areas, it fails to address other reimbursement improvements sought by the HME industry and stakeholders. These include extending the current 75/25 blended rate for non-rural areas beyond the end of the COVID-19 PHE and adjusting rates in formed CBAs to reflect the significant increases in product and operational costs for suppliers since the last completed CBP round in 2015.

The final rule also discloses that CMS has decided to hold off on finalizing any changes to the HCPCS Code Application process. For now, they will continue to review the current system.

NCART is conducting further analysis and will provide additional details soon.

Regards,

Don

Don Clayback
Executive Director | NCART
716-839-9728 (office) | 716-913-4754 (cell)
dclayback@ncart.us | www.ncart.us