WASHINGTON, DC – Upon initial review, the final rule just released by CMS, 1614-F, Medicare Program: End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, has three main points that you need to know about right now.

The final rule released by CMS on Friday was more than 500 pages long, and AAHomecare immediately went to work analyzing the language for its impacts on the HME community. To help the industry comb through this important document, AAHomecare has created a condensed version consisting of the segments related to HME. Download the AAHomecare condensed version.

AAHomecare is continuing to go through the language line by line and will provide an in-depth summary that compares and contrasts what was originally proposed with the final outcomes.

What you need to know:
1. The new adjusted pricing for DMEPOS CBP items will begin on January 1, 2016. This will be a phase-in process over 6 months, allowables will be reduced by 50% on 1/1/16 and 100% on 7/1/16.
2. CMS finalized a pricing methodology for non-competitive bidding areas.
A rural area will be defined as a postal zip code that has more than 50 percent of its geographic area outside of a metropolitan area (MSA) or a zip code that has a low population density area that was excluded from a competitive bidding area. The payment amount will be 110 percent of the average of the SPAs of all the areas where CBPs are implemented.
3. CMS is moving forward with a limited version of its proposed bundling phase-in.
• CMS will move forward with a bundling for power wheelchairs and CPAP in up to 12 markets.
• CMS will not move forward with bundling for: oxygen, standard manual wheelchairs, enteral nutrition, RADs, and hospital beds.

Read the CMS Fact Sheet
Questions? If you’re a member, you have access. Contact Kim Brummett, AAHomecare vice president of Regulatory Affairs, at [email protected].

Addressing the Appeals Backlog
The Office of Medicare Hearings and Appeals (OMHA) is looking for some ideas on how to deal with their increased workload and backlog of appeals.
 AAHomecare has got a few, which is why we attended the OMHA Appellant Forum last week (see video of Tom Ryan’s comments here) and are meeting with Chief Administrative Law Judge Nancy Griswold next week.

AAHomecare has made recommendations to the Office of Appeals at CMS and to Senate Finance Committee staff, and as the voice of the HME industry, will be responding to this request for information from OMHA by the deadline of December 5, 2014.

Specifically, OMHA is seeking input from the public on the current initiatives being undertaken at the Administrative Law Judge level, as well as suggestions for additional initiatives which could be undertaken at OMHA to address the Medicare claim and entitlement appeals workload and backlog at the Administrative Law Judge level.

The request specifically asks for input on the following questions:
• Are there suggestions related to the current initiatives for addressing the increased workload and/or backlog of appeals at the Administrative Law Judge level that comply with current statutory authorities and requirements?
• Are there other suggestions for addressing the increased workload and/or backlog of appeals at the Administrative Law Judge level that comply with current statutory authorities and requirements?
• Are there any current regulations that apply to the Administrative Law Judge level of the Medicare claim and entitlement appeals process that could be revised to streamline the adjudication process while ensuring that parties to the appeals, as defined at 42 C.F.R. 405.902 and 405.906, are afforded opportunities to participate in the process and are kept apprised of appeals related to claims submitted by them or on their behalf?