WASHINGTON, D.C. (December 21, 2021)—The Centers for Medicare & Medicaid Services (CMS) has just released a long-awaited durable medical equipment (DME) rule that includes significant provisions impacting Medicare reimbursement for DME products and services.
The final rule makes permanent the 50/50 blended rate for rural areas, but fails to address other reimbursement measures sought by the American Association for Homecare (AAHomecare) and other DME stakeholders. These include extending the 75/25 blended rate for non-rural areas beyond the end of the COVID-19 Public Health Emergency (PHE) and adjusting rates in former competitive bidding areas (CBA) to reflect the major changes in product and operational costs for suppliers since the last completed competitive bidding round in 2015.
“We’re pleased that the rule secures the 50/50 blend for suppliers in rural areas going forward, helping ensure access to DME in often-underserved communities and offsetting the higher costs of supporting patients over a wider geographical footprint,” said Tom Ryan, AAHomecare president and CEO. “What’s disappointing, however, is that CMS has missed another opportunity to take meaningful action on long out-of-date reimbursement rates for suppliers serving most of the nation’s population.”
“In October, 95 members of Congress encouraged CMS to work with DME stakeholders to adjust rates to account for the increased costs and market realities facing our industry,” added Ryan. “That substantial demonstration of Congressional support for sustainable, market-based DME reimbursement policy gives us a strong starting point for a legislative fix on these insufficient rates.”
The ratemaking provisions go into effect on at the end of the COVID-19 PHE. See the CMS' fact sheet and rule text for additional info.
Additional analysis of the reimbursement provisions and other elements of the final rule is still to come.
