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Fiscal Year 2019: CMS Releases ESRD/DMEPOS Final Rule

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Fiscal Year 2019: CMS Releases ESRD/DMEPOS Final Rule


CMS has released its final ESRD/DMEPOS rule, which contains some, but not all of the additional competitive bidding and reimbursement reforms for which HME stakeholders have been calling.

On November 1, 2018, the Centers for Medicare & Medicaid Services issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2019.

This rule also updates the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI, and finalizes changes to the ESRD Quality Incentive Program. The policies in this final rule aim to increase access to items and services for patients, drive competition, increase affordability, encourage facilities to adopt transformative and innovative therapies, and reward ‘out of the box’ ideas that will produce long-term savings that can be passed on to patients.

This rule also finalizes changes to bidding and pricing methodologies under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP); adjustments to DMEPOS Fee Schedule amounts using information from competitive bidding for items furnished on or after January 1, 2019; new payment classes for oxygen and oxygen equipment and a new methodology for ensuring budget neutrality for oxygen payment classes; and special payment rules for innovative multi-function ventilators or ventilators that perform functions of DME. 

The DMEPOS CBP current contracts for the DMEPOS CBP will expire on December 31, 2018 and the process for recomputing these contracts with suppliers under DMEPOS CBP has not yet been initiated.  Starting January 1, 2019, there will be a temporary gap period in the entire DMEPOS CBP that CMS expects will last until December 31, 2020. During that time, Medicare beneficiaries may receive DMEPOS items from any Medicare enrolled DMEPOS supplier and in most cases, they won’t need to switch suppliers.

In addition, in the proposed rule, CMS solicited comments in a request for information (RFI) on the gap-filling process for establishing fees for new DMEPOS items.  In the final rule, CMS summarizes the comments it received on how the gap-filling process could be revised in terms of what data sources or methods could be used to price new, innovative technologies in a way that complies with the statutory payment rules for DMEPOS items and services.

CMS is committed to transforming the healthcare delivery system and the Medicare program by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improve outcomes. The ESRD PPS and QIP DMEPOS final rule is one of several rules for calendar year (FY) 2019 that reflect a broader Administration-wide strategy to relieve regulatory burdens for providers, support the patient-doctor relationship in healthcare, and promote transparency, flexibility, and innovation in the delivery of care.

For more information, read CMS’s complete text of the final rule.

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