The case for relief in former bid areas 

WASHINGTON – In recent comments to CMS’s DMEPOS proposed rule, AAHomecare introduced the idea of a 90/10 blended reimbursement rate in the former competitive bidding areas. Here’s what Kim Brummett, vice president of regulatory affairs for the association, had to say about what stakeholders hope will be a “reasonable” ask – to base rates in those areas 90% on the current rates and 10% on the 2015 unadjusted fee schedule – and how the industry’s strategy going forward hinges on what ends up in the final version of the rule. 

HME News: Why do former bid areas need relief? 

Kim Brummett: The 50/50 blended rates are permanent in rural areas, which is fabulous, and the 75/25 rates are good through the end of the public health emergency for non-rural, non-bid areas, but the former bid areas essentially got nothing. CMS said, we didn’t get savings (in Round 2021), we’re pulling everything out of the next round (except for braces), and we’re leaving you with the same rates, except for a miniscule 0.6% CPI-U adjustment. When we sat back and thought about that, it didn’t make sense. 

HME: How did AAHomecare land on 90/10? 

Brummett: When non-invasive ventilators were removed (from Round 2021), they reverted back to the 2015 fee schedule, but we felt like that wasn’t realistic. They say bid areas are more highly populated and, therefore, there’s the potential for increased business, so we thought 90/10 would be reasonable. That would get the rates up a little bit, but it wouldn’t be asking too much or wouldn’t be rejected out of hand. The message is, you have the 50/50 and the 75/25 – let’s do something in the former bid areas, instead of nothing, which makes no sense. 

HME: Do we have any idea when CMS will publish the final rule? 

Brummett: The rule came out so late and, at first, we thought they might try to push it through before the change in administration, but now that’s unlikely. They could not release a final rule at all and start over. We’re hopeful the rule will be released in March, April or May, which would allow the industry to see where we’re at and what we might have to do legislatively. If it’s not released in April, I’d be concerned.