Interim Final Rule Provides Regulatory Relief for HME

WASHINGTON, D.C. (March 31, 2019)—Monday evening, the Centers for Medicare & Medicaid Services (CMS) released an Interim Final Rule (IFR) addressing a range of healthcare issues related to the novel coronavirus (COVID-19) outbreak. AAHomecare performed an initial analysis of the IFR that indicates that priority policy recommendations from the HME industry have been included, except for the delay of competitive bidding.

AAHomecare has identified the following provisions pertaining to Durable Medical Equipment included in the IFR:>

1) CMS will not enforce clinical indications for coverage across respiratory, home anticoagulation management and infusion pump National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) (including articles). Enforcement of these clinical indications for coverage will resume once the COVID-19 emergency has ended.

• NCD 240.2 Home oxygen
• NCD 240.4 Continuous Positive Airway Pressure for obstructive sleep apnea
• LCD L33800 Respiratory assist devices (ventilators for home use)
• NCD 240.5 Intrapulmonary percussive ventilator
• LCD L33797 Oxygen and oxygen equipment (for home use)
• NCD 190.11 Home Prothrombin Time/International Normalized Ratio (PT/INR) monitoring for anticoagulation management
• NCD 280.14 Infusion pumps
• LCD L33794 External infusion pumps

2) Face-to-face exams are not required for items that otherwise require them due to NCD or LCD. This does not apply to power mobility devices (PMD), but PMD is already allowed to use telehealth to meet face-to-face requirements.

3) Aligns Medicare and Medicaid regulations on who can order medical supplies, equipment and appliances.

4) Advance payments are available for Part B providers.

The IFR specifically notes, “During the PHE for the COVID-19 pandemic, it is possible that patients receiving services for respiratory related indications will be required to receive care in unexpected settings, including the home. This may be necessary as COVID-19 and other patients are shifted across health care settings to accommodate an increase in patient volume.”

The Interim Final Rule regulations are applicable as of March 1, 2020, and effective immediately. However, providers may submit comments during a 60-day period electronically at regulations.gov, after the IFR is posted.

Full text of the IFR can be found here.

Taking the provisions in the IFR into consideration with the recently enacted CARES Act, AAHomecare has seen significant relief and streamlining of requirements for the industry over the past 10 days. The CARES Act extends the 50/50 blended rate for rural suppliers through the COVID-19 public health emergency (PHE), and also provides a 75/25 blended rate for suppliers in non-rural non-bid areas during that period effective on March 6, 2020. The legislation also suspends the 2% Medicare sequester cuts from May 1 through Dec. 31, 2020. AAHomecare will continue to advocate for additional policy changes to help our industry make its strongest possible contribution to serving patients and reducing burdens on hospitals during the COVID-19 emergency.

Provider Burden Relief FAQ

In addition to the positive announcements from the IFR, CMS published a FAQ on Provider Burden Relief yesterday evening that clarifies that CMS will be suspending most Medicare FFS audits during this PHE and waiving the signature requirement on proof of delivery. CMS will be suspending DME MAC TPE, SMRC, and RAC audits. However, CMS will be able to start reviews during this PHE if there is an indication of fraudulent activity.

CMS will waive the signature requirement for proof of delivery during this PHE due to the difficulty of obtaining signatures during this PHE. Suppliers are to indicate in their records the COVID-19 PHE.

You can find the Provider Burden Relief FAQ here.