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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.
The rule rolls back rates in “rural and non-contiguous” non-bid areas of the country from June 1 through December 31, 2018 to the 50/50 blended rate schedule of 2016. The transition does not affect other non-bid areas of the country. The Rule also makes amendments to existing regulations for DMEPOS items and services for infusion drugs used with DME, as required in the Cures Act.
Section 16008 of the Cures Act requires CMS to consider additional information in making adjustments to the schedule amounts for items and services furnished on or after January 1, 2019, including the cost differences of furnishing equipment in different areas of the country and stakeholder input. A national provider call held in 2017 seeking stakeholder input regarding adjustments in fee amounts brought to light the significant difficulties rural providers face when fully adjusted fees are put in place, details a fact sheet CMS recently released on the Rule.
In a press release, CMS stated, “Today’s action aims to protect access to needed durable medical equipment in rural and non-contiguous areas that are not subject to the DMEPOS CBP, helping beneficiaries to maintain their health, mobility and overall quality of life. Stakeholders have raised concerns about significant financial challenges the current adjusted DME fee schedule rates pose for suppliers, including many small businesses and that the number of suppliers in certain areas continues to decline.”
“This action will help Medicare beneficiaries in rural areas continue to access life-sustaining durable medical equipment, like oxygen equipment,” said CMS Administrator Seema Verma in the press release.
“Today’s action provides substantial and much-needed relief HME suppliers in rural areas—and also for patients, caregivers and clinical professionals in small communities nationwide," said Tom Ryan, AAHomecare president and CEO, in a statement. “We are, however, very disappointed that the relief does not extend to non-bid areas that are not “rural” or “non-contiguous” (e.g., Hawaii vs. Alabama). We strongly believe that more extensive relief is needed, this same relief should have been applied to the rest of the non-bid areas. We are grateful for the limited relief; these adjusted rates will give suppliers in rural areas a chance to keep their doors open while we work towards much-needed long-term fixes for Medicare reimbursement and the bidding program.”
“We appreciate the important role that Congress has played in this process thus far,” noted Ryan. “I believe their strong outreach to CMS and OMB, as well as the conference report language in the recent Omnibus bill encouraging the Administration to release the IFR, played a major part in getting this relief. We need to continue to engage our legislators to let them know that the job isn’t finished.”
At an April House Appropriations Committee hearing with OMB Director Mick Mulvaney, Representative Kevin Yoder (R-Kansas) pressed the director to release the IRF. Mulvaney acknowledged he had received more calls from Congress members about the rule than any other. A transcript of the hearing is available here.
“This IFR is the culmination of a determined campaign by HME stakeholders to get relief for rural suppliers that stretches back over more than two years,” added Ryan, “There is more work to be done, and I hope I can count on the HME community’s continued passion and persistence to build on this measure of relief.”
Approximately 85 percent of the DME industry are considered small businesses, according to the Small Business Administration's size standards with total revenues of $6.5 million or less in any one year. CMS states that the rule will increase payments to small suppliers such that beneficiaries should have improved access to items. CMS also noted a cost-sharing increase for beneficiaries ($70 million), mainly affecting those who do not have supplemental insurance, or who are not dual eligible.
Public comments on the Rule are due by 5 p.m. EST, July 9, 2018.
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