Providers should prepare to move on from PHE

WASHINGTON – CMS has begun setting the stage for the end of the public health emergency and so should HME providers, say stakeholders. 

The agency recently released an overview, “Creating a Roadmap for the End of the Covid-19 Public Health Emergency,” and while it doesn’t provide new information, it summarizes waivers still in place and those that have already expired. 

“Eventually, the PHE is going to come to an end and suppliers need to be thinking about that now,” says Andrea Stark, a Medicare consultant and reimbursement specialist for MiraVista. “They need to make sure they are following the waivers and have expired the ones that have already been terminated.” 

The current PHE is set to expire Oct. 15, but stakeholders believe it will be renewed for another 90-day term – until mid-January of 2023. 

One major area of concern post-PHE: the end of the 75-25 blended reimbursement rate for providers in non-rural areas. That will reset rates back to what they were set several years ago, says Ronda Buhrmester, senior director of payer relations and reimbursement for VGM & Associates. 

“That’s devasting – all costs are up, the cost of goods, payroll expenses,” she said. “I’m not sure providers are prepared to go back to those old rates.” 

Another concern: flexibility around telehealth. While rules around telehealth visits were loosened during the pandemic, for most HME providers, the rules are still very restrictive, says Buhrmester. 

“We have to remember they haven’t changed our requirements from pre-pandemic,” she said. “(Physicians) can do telehealth from home but that’s not acceptable in the DME industry. If (a patient) needs something related to DME, if they don’t fall into certain restrictive requirements, they have to go to the physician in person (in order for DME to be covered). I hope suppliers are aware of that.” 

Generally, now is just a a good time for providers to take a look at what waivers they are still using and why, says Buhrmester. 

“It may be time to pull some reports and start dissecting,” she said. “(They can ask) ‘Why are we still using waivers on this product category?’ and go back to best practices for following the policy. But I do think HME suppliers are ready to move on from the pandemic.”