Medicare Reimbursement Policy

Medicare Competitive Bidding

Round 2021 of the Medicare Competitive Bidding Program for DMEPOS (CB Program) was suspended by the Centers for Medicare and Medicaid Services on October 27, 2020 for all product categories except for of Off-The-Shelf (OTS) Back Braces and OTS Knee Braces.

AAHomecare alert: CMS Pauses Round 2021 For Most Product Categories and Publishes DMEPOS Proposed Rule - 10/27/2020

Currently, all HME suppliers in former competitive bidding areas and non-bidding ares eligible to service Medicare patients. CMS added a 0.6% CPI adjustment for suppliers serving patients in former bidding areas, a measure that "doesn’t reflect the reality that suppliers will be facing in 2021," even after the impacts and operational costs of the COVID-19 pandemic begin to recede.

Suppliers in rural areas receive a measure of relief thanks to a 50/50 blended rate, while suppliers in non-rural areas will receive a 75/25 blended rate through the duration of the COVID-19 Public Health Emergency.

AAHomecare and HME stakeholders worked to convince policymakers to improve the bidding program's price-setting methodology and put in place measures to keep speculative bidders from artificially depressing bid results. CMS is currently developing a new DMEPOS Proposed Rule which will govern Medicare reimbursement policy and CB Program rules going forward. AAHomecare has provided comments to the proposed rule.

Sensible and sustainable Medicare reimbursement policy remains a top priority for AAHomecare. If the Final DMEPOS Rule contains any deficiencies or policies that will negatively impact HME suppliers and the patients, AAHomecare will work aggressively to address and correct these issues.