The Three Biggest Points from the CMS Final Rule on DMEPOS

WASHINGTON, D.C. (Nov. 5, 2014)—Upon initial review, the final rule just released by CMS, 1614-F, “Medicare Program: End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies,” has four main points that you need to know about right now.

The final rule released by CMS on Friday was more than 500 pages long, and AAHomecare immediately went to work analyzing the language for its impacts on the HME community. To help the industry comb through this important document, AAHomecare has created a condensed version consisting of the segments related to HME.

AAHomecare is continuing to go through the language line by line and will provide an in-depth summary that compares and contrasts what was originally proposed with the final outcomes.

What you need to know: 1. The new adjusted pricing for DMEPOS CBP items will begin on Jan. 1, 2016. This will be a phase-in process over six months; allowables will be reduced by 50 percent on Jan. 1, 2016 and 100 percent on July 1, 2016.

2. CMS finalized a pricing methodology for non-competitive bidding areas.

•  A rural area will be defined as a postal zip code that has more than 50 percent of its geographic area outside of a metropolitan area (MSA) or a zip code that has a low population density area that was excluded from a competitive bidding area. The payment amount will be 110 percent of the average of the SPAs of all the areas where CBPs are implemented.

3. CMS is moving forward with a limited version of its proposed bundling phase-in.

•  CMS will move forward with a bundling for power wheelchairs and CPAP in up to 12 markets. 
•  CMS will not move forward with bundling for: oxygen, standard manual wheelchairs, enteral nutrition, RADs, and hospital beds.