CMS issues final ESRD rule

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Thursday, October 31, 2019

WASHINGTON – CMS on Thursday afternoon released an ESRD final rule that establishes a permanent home infusion therapy benefit in 2021 and establishes a methodology for establishing fee schedules for new DMEPOS items.

CMS published the proposed rule in July. The final rule will be published Nov. 8.

Home infusion

Per the rule, CMS will group home infusion drugs into three payment categories, each with a unit of single payment, paid at amounts in accordance with specified infusion codes and units for such codes under the Physician Fee Schedule. CMS also finalized paying higher payment amounts for the first home infusion therapy visit to account for costs to initiate these services. Additionally, in response to public feedback, CMS is soliciting comments on ways to enhance coverage of eligible drugs under the home infusion benefit.

New items

The methodology for establishing fee schedule amounts for new DMEPOS items includes making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within five years of establishing the initial fee schedule amounts

The final rule also:

  • Revises existing policies related to the competitive bidding program
  • Streamlines requirements for ordering DMEPOS items and creates one master list of items that could potentially be subject to the face-to-face requirement and written order prior to delivery and/prior auth requirements.
     

See a fact sheet here.