- CMS has issued an interim final rule that raises Medicare payments for durable medical equipment (DME) to ensure Medicare beneficiaries have access to critical medical devices.
The rule will raise DME payments to Medicare providers from June 1st, 2018 to December 31st, 2018 within rural regions not subject to the DME Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP).
CMS estimates that Medicare will pay an additional $290 million in benefit payments and $70 million in beneficiary cost sharing for DME services during the six-month period.
The agency stated that many small DME providers and businesses experience financial challenges under CMS’s current DME payments rates. Raising the rates would ensure that these smaller businesses can maintain financial stability and effectively provide beneficiaries with devices.
“This action will help Medicare beneficiaries in rural areas continue to access life-sustaining durable medical equipment, like oxygen equipment,” said CMS Administrator Seema Verma.
In 2016 and 2017, the DMEPOS CBP adjusted payment rates for devices like oxygen tanks and enteral nutrition systems in rural areas that are catalogued as “non-bid” areas. These non-bid areas saw adjusted payment rates that were 50 percent lower than unadjusted rates in parts of the country participating in the DMEPOS CBP.
Rural DME providers will now receive “blended rates” from CMS. The blended payment rates are calculated by combining 50 percent of DMEPOS CBP rates and 50 percent of the traditional fee-for-service payment rates.
Stakeholders will have until July 9th, 2018 to submit final comments to CMS about possible DME payment changes here.
“Going forward, CMS will continue to review data and information about rates for DMEPOS items and services,” the agency said. “CMS intends to undertake subsequent notice-and-comment rulemaking to address the rates for durable medical equipment and enteral nutrition furnished in 2019 and beyond.”