WASHINGTON, D.C. – Last week CMS released a consequential Proposed Rule on Home Health and DME that includes new provisions for the next implementation of the Competitive Bidding Program (CBP). In their fact sheet on the Proposed Rule, CMS stresses that they are not currently announcing what product categories they are bidding, nor announcing the specific timeframe for the next bidding round. A future announcement will provide those details.
The Proposed Rule also includes new policies regarding rate-setting methodologies, bid limits, and payment changes for CGMs and insulin pumps. In addition, CMS is proposing updates to the DMEPOS accreditation program, including annual reaccreditation. The rule also outlines a formal exemption process from prior authorization for suppliers that meet specified claim approval thresholds.
Statement from Tom Ryan, AAHomecare President & CEO, on the Newly Released Proposed Rule
AAHomecare is fully prepared to work with the Administration, Congress and the HME sector on this important Proposed Rule.
We need to make sure the procedures and price-setting methodologies in this new bidding round can deliver reimbursement rates that reflect market reality. In advance of Round 2021, HME stakeholders worked hard to secure program improvements like raising the bid ceiling, using clearing prices to set rates, and keeping unqualified bidders from participating—and we are determined to protect and add to those improvements where we can.
Analyzing the new rule and working with the HME community to develop a strong comment response is the first order of business for AAHomecare. We’ll also work with Congress and our clinician and patient advocacy partners as needed to protect access to care. And finally, we will coordinate efforts to educate suppliers to make sure they are equipped with the resources and intelligence they need to make informed bidding decisions.
Preparing for a new bidding round is going to be a major undertaking for everyone in the HME sector. We’ve got to be united and engaged as an industry to meet this moment.
Comment Deadline and Next Steps
Comments on the Proposed Rule will be due 60 days after it is published in the Federal Register (which is set for July 2). The AAHomecare team and leaders on the association’s Regulatory Council will provide additional analysis and perspective in the coming weeks.
Related Links
- CMS Fact Sheeton Proposed Rule
- Medicare and Medicaid Programs: Calendar Year 2026 Home Health Prospective Payment System Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies— full Proposed Rule text (PDF link, 591 page)
- Federal Register Public Inspection Pagefor Proposed Rule
