CMS finalizes durable medical equipment fee schedule

Abstract

CMS announced an adjusted fee schedule for durable medical equipment (DME) sold outside of competitive bidding areas (CBA) in its End-Stage Renal Disease and Durable Medical Equipment Final Rule for 2015. CMS announced an adjusted fee schedule for durable medical equipment (DME) sold outside of competitive bidding areas (CBA) in its End-Stage Renal Disease and Durable Medical Equipment Final Rule for 2015. According to Jillanne Schulte, JD, APhA Director of Regulatory Affairs, the new fee schedule mostly affects rural pharmacists who are not in a CBA. “Overall, it doesn’t really change the major parameters of the DME program,” she said. Essentially, there will be a different methodology for determining what the prices are going to be for areas where there isn’t a competitive bidding program in place, like rural areas. The adjustment, which goes into effect January 1, 2016, is based on a national ceiling of 110% of the average of regional competitive bidding prices and a floor of 90% of those prices. In most cases, even with the higher 110% upper limit, this will result in cuts to reimbursement to rural pharmacies for these supplies.“It’s another option for patients in rural areas, but it will almost certainly decrease payments to rural pharmacists.” “It’s another option for patients who live in rural areas who don’t have the competitive bidding programs, but it will almost certainly decrease payments to rural pharmacists who have not previously been as heavily impacted by the CBP,” said Schulte. Also noteworthy in the final rule are changes to the quality incentive program (QIP) going into effect for endstage renal disease programs. Providers will be paid based on different quality reporting measures that deal with dialysis adequacy, patient care experience, and readmissions, among other things. Dialysis facilities that fail to meet QIP metrics will face reduced payments. However, the program won’t be fully implemented until 2017 and 2018. “They want to give people time to adjust,” said Schulte. She said it’s still unclear if pharmacists will be on the hook to report under the new QIP requirements.