WASHINGTON—Centers for Medicare & Medicaid Services (CMS) has published the Consumer Price Index for All Urban Consumers (CPI-U) adjustments for the Calendar Year 2024 DMEPOS fee schedule. The CPI-U is 3%, however, the inflation adjustment differs depending on whether the item has been included in the competitive bidding program (CBP) and whether the patient’s zip code is in a former competitive bidding area (CBA). Below is a breakdown provided by the American Association for HomeCare (AAHC):
• CBP items in former CBAs (projected percentage change): +2.9%
• CBP items in non-CBAs (CPI-U): +3%
o Note: not directly stated in the change request
• Non-CBP items (CPI-U minus productivity adjustment): +2.6%
What This Means for CBP Items in Former CBAs
For items such as CPAP devices, oxygen and NPWT where the payment is based on CBP payment rates, the 2.9% inflation adjustment should be directly reflected in the fee schedule in CY2024.
What This Means for Non-CBP Items
For items that have never been part of the CBP, such as urological and ostomy supplies, the 2.6% inflation adjustment should be directly reflected in the fee schedule, regardless of location in the country.
What This Means for CBP Items in Rural Areas
For CBP items in rural areas, the 50/50 blended rate will continue to be applied (50% fully adjusted regional payment/50% unadjusted fee schedule from 2015) meaning the 3% increase will only be applied to the fully adjusted portion of the calculation. As such, the portion of the reimbursement calculation that is based on the static 2015 rates will remain the same, but the fully adjusted portion will increase by 3%.
- The 2024 rate = 50% derived from the 2015 rates, 50% derived from the current regional rates + 3% increase.
What This Means for CBP Items in Non-Rural
For CBP items in non-rural areas, the payment rate will depend on Congress passing extensions to the 75/25 (75% fully adjusted payment/25% unadjusted fee schedule from 2015) relief rates. If relief is extended, the portion of the reimbursement calculation that is based upon the static 2015 rates will remain the same, but the fully adjusted portion will increase by 3%. For non-bid, non-rural areas, the 2024 rate = 25% derived from the 2015 rates, 75% derived from the current regional rates + 3% increase. However, if Congress fails to pass an extension, the payment rate for CBP items non-rural areas starting in CY 2024 will be 100% of the adjusted regional rate.
"Thanks to advocacy efforts by the HME community, we have advanced legislation to extend the 75/25 rates for 2024 through both the House Energy and Commerce Committee and Senate Finance Committee and are working to have them included in appropriations legislation expected early next year," AAHC said. "See our recent Insider article for more details on legislative activity."
