CMS' home health payments proposal includes updates to the Competitive Bidding Program, changes to home medical equipment accreditation and more

WASHINGTON—The proposed rule for 2026 home health payments that the Centers for Medicare & Medicaid Services released earlier this month includes a wide range of changes that will impact home medical providers, including updates to competitive bidding, accreditation requirements and prior authorization policies.

The new rule includes new policies regarding rate-setting methodologies, bid limits & payment changes for continuous glucose monitors

WASHINGTON—The Centers for Medicare & Medicaid (CMS) released a proposed rule on home health and durable medical equipment (DME) that includes new provisions for the next implementation of the Competitive Bidding Program (CBP), the American Association for Homecare (AAHomeCare) shared in an email with its members. 

The agency's budget request for the 2026 fiscal year is explained in its Budget in Brief

WASHINGTON—The Department of Health and Human Services (HHS) released more details on the agency’s budget request for the 2026 fiscal year in its 51-page Budget in Brief, along with a 194-page Justification of Estimates for Appropriations Committees for the Centers for Medicare and Medicaid Services (CMS).


Fee increase and beneficiary cost sharing noted as points to watch.

By Kristin Easterling

(May 10, 2018)—After months of advocacy from AAHomecare and other industry stakeholders, the Office of Management and Budget (OMB) and CMS have cleared the Interim Final Rule related to HME (CMS-1687-IFC) to increase fee schedule rates for certain DME items and services through 2018. Language in the recent Omnibus bill also urged the Administration to release the rule and move on relief for rural providers.

Leadership walked away encouraged and ready to move forward.

—Via AAHomecare WASHINGTON, D.C. (April 5, 2017)—On Tuesday afternoon, AAHomecare president Tom Ryan, Jay Witter, AAHomecare senior vice president of public affairs, Cara Bachenheimer, senior vice president of government relations with Invacare, and Thomas Barker, an attorney recently engaged by the Association, met with CMS Administrator Seema Verma and Deputy Administrator Demetrios Kouzoukas, as well as several other HHS and CMS staffers.

WASHINGTON, D.C. (October 31, 2016)—CMS issued a final rule last week, covering end-stage renal care and changes to the DME competitive bidding program. Provisions of interest to the home medical equipment community include:

Bid Ceilings—Bid ceilings for future rounds will be based on the 2015 fee unadjusted fee schedule, instead of CMS's earlier proposal to establish bid ceilings at the current CBA pricing.


LENEXA, Kan. (October 27, 2016)—Mediware Information Systems, Inc. is hosting a free webinar for attendees on Thursday, December 1, 2016, at 1:00 Central, 2:00 EST, to discuss how providers can expand their business outside of Medicare. The webinar is entitled “Responding to Medicare Cuts: Details About Billing Non-Assigned, ABNs, and Retail,” presented by Jeffrey S. Baird, of Brown & Fortunato, P.C.

WASHINGTON, D.C. (June 29, 2016)—On June 24, CMS issued a proposed rule that would update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2017. This rule also proposes new quality measures to improve the quality of care by dialysis facilities treating patients with end-stage renal disease.

Washington, D.C. (May 12, 2016)—The highly anticipated companion bill to S. 2736, the Patient Access to Durable Medical Equipment (PADME) Act, was introduced in the House of Representatives on Thursday, May 12, 2016. H.R. 5210 was introduced by Representatives Tom Price, M.D. (R-Ga.) and Dave Loebsack (D-Iowa). This bill has gathered broad bi-partisan support as it has been introduced with 40 original co-sponsors including Reps.


WASHINGTON, D.C. (April 20, 2016)—Leaders of the Senate Finance Committee have asked the U.S. Department of Health & Human Services (HHS) to delay the next round of bidding-derived reimbursement cuts for rural and non-bid areas for an additional twelve months and to disclose specific indicators the agency is using to monitor possible beneficiary access issues under the Medicare bidding program for home medical equipment.