CMS Issues Final Rule Affecting Requirements, Payments for DMEPOS Items

The rule, which will take effect next year, also streamlines the requirements for ordering DMEPOS products.

• By Haley Samsel
• Nov 07, 2019

Beginning on Jan. 1, 2020, providers can expect to see changes in how CMS calculates fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services.

The 2019 ERSD/DMEPOS Final Rule issued by CMS on Oct. 31 outlines the agency’s new methodology, which is commonly called “gap-filling.” In an email to members on Nov. 1, the American Association for Homecare explained how the new process will work.

“For newly introduced DMEPOS items, CMS will identify existing comparable items (or a single item, where applicable) and uses the fee schedule of the comparable item(s) to calculate the new item’s fee schedule,” AAHomecare wrote in a public statement. “CMS will use a new framework to standardize the methodology in identifying the comparable item(s) and will use verifiable supplier/commercial price listings when there are no identifiable comparable items.”

In addition, the final rule streamlines the requirements for ordering DMEPOS items, creating one Master List of items, according to a CMS fact sheet. The agency is planning to adjust the requirements for items that can be subject to face-to-face encounter, written order prior to delivery, and/or prior authorization, AAHomecare said.

Under the new rule, contracted suppliers will only be required to notify CMS of a change of ownership by 10 days after the effective date. Prior to the change, contracted suppliers were required to notify the agency 60 days before the effective date.

At press time, AAHomecare was close to releasing its full review of the final rule and an assessment of the rule's implications for the industry.