In its proposed 2020 rule for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), the US Centers for Medicare and Medicaid Services (CMS) aims to make payments for devices a little more predictable in light of the ever-increasing—and ever-advancing—range of options available to providers and patients. The agency's solution? A "comparable item analysis" system that CMS thinks will help make it easier to nail down exactly what Medicare will pay for those devices.
In what a CMS fact sheet describes as an attempt to "improve the transparency and predictability of establishing fees for new DMEPOS items," the proposed rule establishes 5 major categories under which providers can compare older DMEPOS with new ones: physical components, mechanical components, electrical components (when applicable), function and intended use, and "additional attributes and features."
The idea, according to the proposed rule, is that when the old and new items are comparable, CMS will use the fee schedule amounts for the existing older item in determining payment amounts for the new one. If there are no comparable older items, CMS says it will base payment on commercial pricing data such as internet pricing and supplier invoices. Those prices for the noncomparable items won't necessarily stay fixed: if commercial pricing drops, so will CMS rates.
In addition to the comparison system, CMS is also proposing to revamp requirements around face-to-face meetings between providers and patients in need of DMEPOS that "may have created unintended confusion for stakeholders." The current requirements—essentially a collection of ad-hoc provisions that have accrued over the past 13 years—would be replaced with what CMS describes as a "single list of DMEPOS items potentially subject to a face-to-face encounter and written orders prior to delivery, and/or prior authorization requirements."
APTA is analyzing the proposed rule and will provide comments to CMS by the September 27 deadline.