Home Health Care Management: CMS Publishes 2015 Rate Fact Sheet.
As of Monday, November 10th CMS (Centers for Medicare and Medicaid Services) have issued their final rule regarding the payment adjustments for DME (durable medical equipment). The final rules come down amid the midst of several new policy changes within the realm of Medicare reimbursements for the year 2015.
The new rules clarify several distinctions regarding the exact criteria related to DME supplies, such as methodology and classification. The regulation also outlines other programs such as the competitive bidding for rural areas and monthly payment bundling for these particular bid areas.
Other areas of the regulation outline additional changes to the fee schedules system. While there aren’t as many distinct changes from the original proposal set forth in July, there have been several modifications to the ceiling and floor prices of items that are dependent upon the actual regional prices. Currently, the scheme is as follows:
- National Ceiling – 110% of the average of regional prices
- Floor – 90% of the average regional prices
“Non-contiguous” areas will also see fees adjusted dependent upon their regional competitive bid price averages, or the national ceiling- whichever prices is highest. The following excerpt directly from the regulation explains where the national ceiling provides will be utilized:
- Adjust fee schedule amounts for items and services based on regional prices limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional prices)
- Adjust fee schedule amounts for non-contiguous areas based on the average of competitive bidding pricing from these areas or the national ceiling, whichever is higher.
The rule finalizes an expanded policy for rural payment by specifying that the national ceiling will be extended to any area outside an metropolitan statistical area (MSA) designated as a rural area, regardless of whether the state meets the definition of a rural state.
Additionally, special payment rules have been outlined and clarified within the final document as well:
Phase-in of special payment rules in a limited number of areas under the CBP for certain DME: This rule finalizes a limited phase-in of continuous bundled monthly payments for the equipment, supplies, accessories and any necessary maintenance and repairs for standard power wheelchairs and continuous positive airway pressure (CPAP) devices furnished under the CBP in place of capped rental policies. The specific details for phase-in of this special payment rule to competitive bidding areas will be addressed through guidance.
The definition for an MSA (metropolitan statistical area) has been specified as any zip codes that “have more than 50% of its geographic area outside of a MSA, or those that have a low population density—regions at least 400-square miles in area with a population density of no more than 35 people”. These particular areas will be subject to the national ceiling rates (110% of national average), regardless of whether or not their state is defined as a “rural state”.
In addition to the bidding and payment rates, the final document also outlines changes made to rates for End-Stage Renal Disease Facilities for CY 2015, prosthetics, orthotics, and supplies. You can read the full official fact sheet published by CMS in the link below.
