Amid concerns that dwindling numbers of enrolled DME suppliers were depleting rural patients’ access to necessary equipment and services, CMS increased rural payment amounts in June 2018. To do so, the agency averaged the adjusted fee schedule rates derived from competitively bid single payment amounts with higher unadjusted amounts in affect before the adjusted rates took effect. Rural suppliers have survived on these 50/50 blended rates for almost two years, but they are scheduled to expire on December 31, 2020.
CMS, absent legislation, is not likely to extend relief after 2020 because the agency believes competitive bid reform will deliver more sustainable rates through the Round 2021 contracts that take effect on January 1, 2021. The industry, understandably, remains skeptical the reform-driven rates can sustain suppliers or stabilize patient access to care.
The Protecting HOME Act (H.R. 2771) could provide legislative relief. The currently pending legislation contains protections for sustainable rates outside competitively bid areas, both rural and non-rural. It:
One hopes for rational legislation, but …
There is a real possibility that rural suppliers will have to absorb rate cuts on traditional products like CPAP, oxygen, beds, and support surfaces, as well as competitively bid Round 2021 products like ventilators and braces. Aside from urging support for legislative carveouts like HR 2771, savvy suppliers can take certain matters into their own hands. By using the remainder of this year to increase efficiency and diversify payer/product concentrations, suppliers will be positioned to weather the uncertain ramifications for Round 2021.
SOURCE LINKS
https://www.congress.gov/bill/116th-congress/house-bill/2771
CMS, absent legislation, is not likely to extend relief after 2020 because the agency believes competitive bid reform will deliver more sustainable rates through the Round 2021 contracts that take effect on January 1, 2021. The industry, understandably, remains skeptical the reform-driven rates can sustain suppliers or stabilize patient access to care.
The Protecting HOME Act (H.R. 2771) could provide legislative relief. The currently pending legislation contains protections for sustainable rates outside competitively bid areas, both rural and non-rural. It:
- Permanently continues the 50/50 blended rate for rural areas, and
- Requires CMS to calculate payments in non-rural areas using a blend of the unadjusted fee schedules (25%) and competitive bidding fee schedules (75%).
One hopes for rational legislation, but …
There is a real possibility that rural suppliers will have to absorb rate cuts on traditional products like CPAP, oxygen, beds, and support surfaces, as well as competitively bid Round 2021 products like ventilators and braces. Aside from urging support for legislative carveouts like HR 2771, savvy suppliers can take certain matters into their own hands. By using the remainder of this year to increase efficiency and diversify payer/product concentrations, suppliers will be positioned to weather the uncertain ramifications for Round 2021.
SOURCE LINKS
https://www.congress.gov/bill/116th-congress/house-bill/2771
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