CMS sticks with 'flawed' pricing during gap period

WASHINGTON - CMS appears to have done little to change its competitive bidding-related rule from the time it was proposed in July until it was finalized on Nov. 1.

Despite myriad concerns raised by HME industry stakeholders, the agency did not extend 50/50 blended reimbursement rates to all non-bid areas; and it did not apply CPI adjustments to rates in bid areas retroactively from 2008-13.

“While I believe that CMS is making a smart decision in pausing the bidding program to work on additional fixes, I'm disappointed that the agency is allowing pricing generated under this flawed program to stay in place until the next bidding round,” said AAHomecare President and CEO Tom Ryan in a statement. “Suppliers can't wait for the more sustainable rates that we expect from future rounds of an improved bidding program. They need relief now.”

The final rule, like the proposed rule, implements a gap period from Jan. 1, 2019, through Dec. 31, 2020, whereby any Medicare-enrolled provider can supply DMEPOS until new contracts are awarded under the next round of the program. The rule also establishes a new method for determining single payment amounts using maximum winning bids and lead-item pricing.

The fight isn't over, Ryan says. Stakeholders will rely on the same “exceptional grassroots efforts” from providers, state association partners and other stakeholders as they press for more relief* for providers in bid and non-bid areas before the next round of the program, he says.

“We've strengthened our capacity to get Capitol Hill educated and engaged on our policy priorities, which has been critical in convincing regulators to take a close look at the bidding program,” he said.

The final rule also creates a new class for portable liquid oxygen equipment by splitting the existing class of portable gas and portable liquid oxygen, and changes the way budget neutrality is calculated by applying the offset to all oxygen and oxygen equipment classes beginning Jan. 1.

Despite the absence of added relief in the final rule, as stakeholders had requested, CMS Administrator Seema Verma stated in a press release: “Based on many comments we received on our DME proposal from suppliers, manufacturers and their associations—all of whom supported our proposals—we are implementing market-oriented reforms to Medicare's DMEPOS competitive bidding program that also reduce burden on suppliers by simplifying the bidding process.”