WASHINGTON, DC – The renewal of the COVID-19 Public Health Emergency (PHE) declaration for another 90-day term means that reimbursement rate relief delivered through the CARES Act and relaxed regulations/requirements granted by CMS, state Medicaid authorities, and several other payers will be extended though at least October 22.

Taken together, these measures will help HME suppliers weather revenue losses and increased costs associated with the pandemic, allowing our industry to continue to provide a high level of care and help alleviate the burdens on hospitals and other parts of our healthcare infrastructure.

Relief for our industry remaining in effect under the PHE includes:

• Medicare 75/25 blended rate for non-rural/non-bid suppliers (according to our analysis, these areas are receiving rate increases of about 30% overall)
• Medicare 50/50 blended rate for rural suppliers (this measure remains in effect through the end of this year or the end of the PHE, whichever is later)
• 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.
• 2% increase in Medicaid FMAP match (will remain in effect though the end of the quarter the PHE expires, so this relief will run through at least the end of 2020)
• State Medicaid waivers and flexibilities tied to the PHE
• TRICARE reimbursement increases tied to the Medicare rate relief

The extension of the PHE is likely to remain a factor for how quickly CMS fully renews audit activities, as well for other third-party payers in determining how long to maintain relaxed requirements for HME.

AAHomecare’s Regulatory Council is developing policy recommendations for adopting some of these flexibilities on a permanent basis, including the expanded utilization of telehealth.

MEDCAC Meets to Provide Guidance on Coverage Criteria for NIPPV 

WASHINGTON, DC – The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) held a virtual meeting regarding the use of noninvasive positive pressure ventilation (NIPPV) devices in COPD patients. This meeting was intended to provide CMS guidance on coverage criteria for NIPPV devices such as CPAP, BiPAP, and ventilators.

During the meeting, the MEDCAC Panel received presentations on current studies and discussed the findings. Overall, the panelists agreed that the patient population that needs to use NIPPV is diverse, there is unique value to the different devices, and patients need access to the best device that is suited for their condition.  The panelists also agreed that there is no evidence to support a requirement for four hours of use for CPAP and there is no evidence to support setting a time requirement.

Although MEDCAC aids CMS with setting coverage criteria, CMS still has the autonomy to ultimately determine the coverage criteria. CMS will be reviewing MEDCAC’s discussions and may choose to update relevant NCDs.

DME MAC Update on CARES Act Rates

WASHINGTON, DC – As noted in the May 13 AAH Insider, the DME MACs have been directed by CMS to reprocess claims from March 6-April 22, 2020 that should have received the CARES Act relief rates (blended rate of 75% adjusted and 25% unadjusted). Only CBP items in non-rural, non-CBAs are impacted by this instruction.

This week, CGS clarified that there is no action needed by suppliers and that the DME MACs will automatically reprocess claims that meet the following criteria:

• Dates of service between 3/1/2020-4/22/2020
• HCPCS/Modifier combination listed in Attachment A of CR 11784(page 8-25)
• Claim line was previously paid

The DME MACs will notify suppliers via listserv once the automated adjustments are completed. Once the DME MACs have completed the adjustments, the DME MACs will then begin adjusting claims with the KE modifier that are listed in Attachment B of CR 11784 (page 26-32). To get items listed under Attachment B reprocessed, suppliers will need to notify the DME MACs by submitting a KE modifier reopenings/adjustments request once the DME MACs complete the automated adjustments for items listed in Attachment A.

You can find CGS’ update here.

CMS Resuming Some Accreditation and Enrollment Activities

WASHINGTON, DC – In an updated the Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs), CMS removed several flexibilities that were in place for the Public Health Emergency (PHE). Effective July 6, CMS resumed DMEPOS site visits (Supplier Standard #7), accreditation and reaccreditation activities, and enrollment site visits.

Earlier in the PHE, in an effort to protect patients and employees, CMS waived accreditation and reaccreditation activities, enrollment site visits, and waived the following supplier standards:

• Physical Location Access (Supplier standard #7)
• Requirement for Primary Business Telephone (Supplier standard #9)
• Minimum Hours of Operation (Supplier standard #30)

In this updated Provider Enrollment FAQ, it states CMS will continue to waive supplier standards #9 and #30 but will resume supplier standard #7. CMS will also resume provider enrollment site visits. The inspector will be adhering to all requirements (state and local) regarding personal protective equipment when conducting the site visit.

CMS will also resume accreditation and reaccreditation activities. Depending on the state’s reopening plan, surveys will be conducted onsite, virtually, or combination of both. New DME suppliers that enrolled during the PHE that have not been accredited will receive a notification from the National Supplier Clearinghouse (NSC) and will have 30 days to complete an application to an Accrediting Organization. Similarly, suppliers who received an extension of their expiring supplier accreditation will receive a notification from the NSC to begin the reaccreditation process.

This announcement can be found on pages 9-10 of the Provider Enrollment FAQ.