WASHINGTON, DC – Earlier this month, outgoing HHS Secretary Alex Azar announced that the COVID-19 Public Health Emergency (PHE) declaration would be renewed for an additional 90-day term, effective today, January, 21. The extension keeps significant measures of COVID-19 relief for our industry in effect until at least April 21, 2021, including:
- Medicare 75/25 blended rate for non-rural/non-bid suppliers and Medicare 50/50 blended rate for rural suppliers.
- NCD/LCD flexibility allowing expanded use of home-based respiratory products/therapy, as well as infusion and anticoagulation devices.
- Waiver of face-to-face requirements for many products; allows use of telehealth for PMD F2F requirement.
- 6.2% increase in Medicaid FMAP match will remain in effect though the end of the quarter the PHE expires, so this relief for state Medicaid agencies will run through at least June 2021.
- State Medicaid waivers and flexibilities tied to the PHE.
- TRICARE reimbursement increases tied to the Medicare rate relief.
New Legislation Seeks to Further Extend Pause of Sequestration Cuts
In December, Congress extended the pause on the 2% Medicare sequestration cuts that were set to expire at the end of 2020 through March 2021. Last week, Reps. Brad Schneider (D-IL) and David McKinley (R-WV) introduced H.R. 315, new legislation to continue the moratorium on the Medicare sequester cuts though the duration of the PHE. AAHomecare will again support this effort and work to generate support from the HME community for the legislation.
CMS Releases Round 2021 Bid Data
WASHINGTON, DC – CMS released results from the Round 2021 bidding process. The prices generated across 13 product categories in 130 Competitive Bidding Areas (CBAs) vary widely, with both increases and decreases across CBAs. Overall, Round 2021 bid results for lead items show increases in most areas compared to the 2020 fee schedule, while prices generated for non- lead items show mixed results.
When CMS announced their decision not to implement results from Round 2021 in late October 2020, the Agency stated their action was based on their finding that “payment amounts did not achieve expected savings.” Round 2021 lead item data released Friday confirms that rationale. While it appears to support HME stakeholders’ concerns that the current SPAs are too low, it is important to analyze the data and understand the variations to avoid potential unintended consequences that could result in CMS eliminating the critical gains achieved during the last several years.
AAHomecare is continuing to work on improving transparency of the bidding program and has submitted a Freedom of Information Act (FOIA) request for additional transparency on the Round 2021 bids. Specifically, AAHomecare has requested the following data for each of the 130 CBAs and 13 product categories:
- Number of Bid Bonds Issued
- Number of Bids Submitted
- Number of Bona Fide Bid Requests
- Number of Disqualified Bidders
- Number of First Time Bidders
- Number of Disqualified Bidders Due to Preliminary Bid Evaluation
For more details on the Round 2021 bid results, see CMS’ announcement and pivotal bid results.
CMS Publishes Final Rule on Innovative Technology
WASHINGTON, DC – On January 14, CMS published the final rule to the August 30, 2020 proposed rule titled: Medicare Coverage of Innovative Technology and the Definition of “Reasonable and Necessary”. The rule finalizes a new coverage program called “Medicare Coverage of Innovative Technology” (MCIT) which would streamline “FDA-designated breakthrough medical devices” to get Medicare coverage up to four years. The final rule also codifies the “reasonable and necessary” definition with some modifications.
This final rule is effective March 15, 2021. You can find AAHomecare’s summary here.
AAHomecare Seeks Data on Supplier Costs
WASHINGTON, DC – AAHomecare remains committed to establishing sustainable reimbursement rates for DME. Since CMS suspended Competitive Bidding for most DME products, suppliers remain largely subject to rates that were bid in 2016 and do not cover the current costs of doing business, including new cost and operational requirements stemming from the COVID-19 pandemic.
AAHomecare has developed a survey to demonstrate to CMS and legislators how much DME costs have increased since the single payment rates from the last round of CB were established. Your participation in this CONFIDENTIAL survey will allow us to understand how much product and parts’ acquisition costs have increased. Rest assured, information will only be shared in aggregate; no individual survey respondent’s data will be identified.
Please share your information by Friday, February 5. You can find the survey here. Contact Ashley Plauché at [email protected] with any questions.
