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CMS Removes Most Product Categories from CB Round 2021 and Publishes DMEPOS Proposed Rule

Tuesday evening, CMS announced that there will be no Round 2021 competitive bidding contracts awarded for product categories bid in this round, with the exception of Off-The-Shelf (OTS) Back Braces and OTS Knee Braces. Winning bidders for OTS back and knee braces will have until Nov. 10 to respond to the contract offer(s). See CMS' announcement on this significant Round 2021 change for additional details.

The Agency also released a long awaited DMEPOS rule that includes provisions that AAHomecare and other industry stakeholders have advocated for.

“HHS and CMS are making the right call here,” said Tom Ryan, AAHomecare president & CEO. “Removing the majority of HME product categories from Round 2021 will allow suppliers to effectively serve their communities as the public health emergency continues, and also provide care for individuals with long-term healthcare challenges as they recover from COVID-19.”

In their announcement, CMS also notes that they are not awarding contracts for 13 product categories for Round 2021 that were previously bid as the "payment amounts did not achieve expected savings."

"We appreciate CMS' transparency in sharing that Round 2021 bids didn't result in significant savings," added Ryan. "These products have been bid multiple times, and we've found a payment floor.  Competitive bidding should end for these products permanently."

Ryan continued: "Once we're clear of this pandemic, policymakers, HME stakeholders, clinician organizations, and patient groups should take advantage of the opportunity to develop a new system for Medicare reimbursements. It's time to move on to a better approach that expands access to HME as the patient population that depends on these products and services continues to grow."

“I want to thank leadership at HHS and CMS for their decisive action,” Ryan said. “These Agencies have made strategic moves to relax regulatory requirements and allow healthcare providers to operate more effectively during the pandemic, and this announcement is another example of their strong response to this crisis.”

CMS has also released a long-awaited proposed rule on Medicare DMEPOS payment policy that proposes:

  1. Continuing current relief for rural HME suppliers (50/50 blended rate). Other non-bid area suppliers will be paid at 100% of the adjusted fee schedule.
  2. Exclusion of Complex Rehab manual wheelchairs and certain other manual wheelchairs, and accessories used with them, from the bidding program.
  3. Changes related to the Healthcare Common Procedure Coding System (HCPCS) Level II Code Application Process
  4. Changes to the process for making Benefit Category Determinations and Payment Determinations for DME and other Items and services under Part B
  5. Changes to the classification and payment for Continuous Glucose Monitors under Part B
  6. Expanded classification of External Infusion Pumps as DME

CMS is considering extending the current transition payment rules that have been in effect in former competitive bid areas during 2019 and 2020 for items in the 13 product categories that have been removed from Round 2021.

“The COVID-19 pandemic underscores the critical role that HME plays in supporting our nation’s healthcare infrastructure,” Ryan concluded. “Going forward, we need to make sure that policymakers and private payers understand that patients, caregivers, clinicians, and communities will benefit with a stronger investment in home-based care.”

Comments on the proposed rule are due in 60 days.  AAHomecare will provide further analysis on the rule soon.

More information can be found in the proposed rule and related fact sheet