CMS Releases Final Rule on DMEPOS Competitive Bidding and Potential Changes to Gap Filling Methodology

On November 1, 2018 the Centers for Medicare and Medicaid Services (CMS) published a final rule that addressed changes to the DMEPOS Competitive Bidding program and potential changes to the gap filling methodology that is currently used to establish Medicare fee schedules for new HCPCS codes.

The final rule followed a proposed rule that was published on July 11, 2018.  AOPA submitted comments on the proposed rule on September 10, 2018.  The competitive bidding and gap filling provisions addressed in the final rule are part of the larger final rule entitled, “Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments to Correct Existing Regulations Related to the CBP for Certain DMEPOS”.  This is a rule that is published annually to update the Prospective Payment system for the Medicare prospective payment system for the Medicare End Stage Renal Disease program but has also been used to announce changes to the DMEPOS competitive bidding program.

The final rule confirmed that there will be at least a two year pause in the Medicare DMEPOS competitive bidding program while the provisions of the final rule are implemented, and new contract proposals are solicited and evaluated for award.  In the final rule, CMS does not expect the next round of competitive bidding to begin prior to January 1, 2021.

The provision of the proposed rule that is of greater immediate interest to AOPA members is one that requested input on improving the gap filling methodology that is currently used to establish Medicare fee schedule amounts for new HCPCS codes.  In the proposed rule, CMS announced that it was soliciting comments on how to improve the gap filling process.  In its comments, AOPA recommended that the gap filling process must be completely transparent and must be modernized to include accurate resources when establishing Medicare fees.  While CMS received significant comments on the gap filling process, it declined to initiate any changes to the gap filling process as part of the final rule.  The final rule only acknowledged the comments on the gap filling process and indicated that it would consider the recommendations that were submitted.

AOPA will continue to communicate with CMS regarding ways to improve the gap filling process and will report any changes to AOPA members.