Increased Attention Needed on TRICARE Rates

—Via AAHomecare, WASHINGTON, D.C. (June 7, 2017)—With the publishing of the fee schedule by CMS, the HME industry is still awaiting the Department of Defense Health plans and timeline for implementing the Cures Act. AAHomecare recently sent a letter reminding the Department of Defense that CMS will comply with Congress’s mandate by reprocessing DMEPOS claims with date of service between July 1 and December 31, 2016 and pay those claims according to the new fee schedule published for July 1, 2016. AAHomecare reiterated its belief that the statutory and regulatory authorities that govern the TRICARE program, the TRICARE reimbursement manual provisions on reimbursement for DME and TRICARE DME network agreements, compel the Defense Health Agency to do the same.

The letter clearly defined expectations, stating:

1. 16007 directs the Secretary to delay the application of the SPA based adjusted fee schedules to January 1, 2017… It is our understanding that the Centers for Medicare and Medicaid Services (CMS) will implement § 16007 by reprocessing DME claims with DOS between July 1, and December 31, 2016 so that suppliers receive the DMEPOS fee schedule rate effective January 1, 2016. Based on our review of the applicable authorities we request that you do likewise at your earliest opportunity.

2. Tricare reimbursement for DMEPOS follows the DME fee schedules pursuant to both statutory and regulatory authority. The statute authorizing TRICARE and its implementing regulations peg TRICARE reimbursement for DMEPOS to Medicare DME payment amounts and methodologies. And importantly, TRICARE DMEPOS network agreements do so as well.

With uncertainty over the way TRICARE will implement the Cures Act, AAHomecare is asking all providers who are even remotely involved in TRICARE to help increase the amount of attention and urgency on this issue. AAHomecare has put together a letter for you and your colleagues to send to the Defense Health Agency.

For information, contact Laura Williard, senior director of payer relations, [email protected].

Visit aahomecare.org for more information.