CMS releases final bid-related rule

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Thursday, November 1, 2018

WASHINGTON – CMS has released the anxiously awaited DMEPOS/ESRD Final Rule—without increasing payment amounts in former competitive bidding areas during the gap period.

“We believe that the CY 2019 ESRD PPS DMEPOS proposed rule, which we are finalizing, will result in adequate fee schedule amounts given that the SPAs that the adjusted fees are based on are the same amounts that have been used to adjust the fee schedule amounts for non-rural non-CBAs since Jan. 1, 2017,” the agency stated in the rule. “We believe that adjusting fees based on maximum winning bids would result in excessive payments.”

Industry stakeholders recommended that CMS establish rates in the former CBAs at the current SPA rates but provide an increase to those rates by all the CPI-U increases from 2013 through 2018. It also argued for applying 50-50 blended rates not only in rural and non-contiguous areas from Jan. 1, 2019, through Dec. 31, 2020, but also in the remaining non-bid areas.

The process for re-competing bid contracts has not been initiated and CMS expects the resulting gap period to last until Dec. 31, 2020.

The rule also finalizes the Medicare fee schedule payments for DME furnished on after Jan. 1, 2019 in areas of the country where competitive bidding is not in effect.

“The rule finalized today makes innovative changes to the Medicare payment rules for the durable medical equipment and end-stage renal disease programs,” said CMS Administrator Seema Verma in a press release. “It also helps to ensure continued access to durable medical equipment and makes significant improvements to our competitive bidding system.”