CMS slashes payments for durable medical equipment by as much as 50% in some cases
New amounts reduce Medicare and beneficiary out-of-pocket expenses by about half.
The Centers for Medicare and Medicaid Services has released adjusted rates for durable medical equipment and supplies that save the program and beneficiaries about half of the current spend.
The new rates, initiated on January 1, are being fully implemented on July 1, CMS said.
The durable medical equipment, prosthetics, orthotics and supplies rates save Medicare and beneficiaries about half of what was previously spent for three commonly used rental items: an oxygen concentrator, a hospital bed and a powered pressure-reducing air mattress.
For an oxygen concentrator payment over six months, the supplier will be paid $472 in urban areas and $520 in rural areas. This compares to the 2015 fee schedule, in which the supplier was paid $1,086, on average.
The beneficiary's coinsurance drops from $217 to $94 in urban areas and from $217 to $104 in rural areas.
In hospital bed payments for six months, the supplier will be paid $318 for furnishing the bed in urban areas and $349 for furnishing the bed in rural areas. This compares to the 2015 fee schedule in which the supplier was paid $705, on average.
The beneficiary's coinsurance will drop from $141 to $64 in urban areas and from $161 to $70 in rural areas.
For a powered mattress for six months, beginning July 1, the supplier will be paid $1,002 for furnishing the mattress and pump in urban areas and $1,084 for furnishing the mattress and pump in rural areas.
Under the 2015 fee schedule, the supplier was paid $3,478 on average.
The beneficiary's coinsurance will drop from $696 to $200 in urban areas and from $696 to $217 in rural areas.
The new rate schedule reflects "single payment amounts," which were determined using bids submitted by DMEPOS suppliers.
CMS initiated the payment adjustments on January 1. The six-month transition period to July 1 allowed CMS to monitor health outcomes and access to these items and services.
[Also: CMS sets single payment amounts for durable medical equipment, supply contracts]
Adjustments to the fee schedule amounts must continue to be made as additional items are added to the competitive bidding program, or as competitive bidding contracts are recompeted, the latter of which occurs every three or more years, CMS said.
The July 1 adjusted DMEPOS fee schedule amounts have been revised to factor in new pricing information from the Round 2 Recompete and National Mail Order Recompete programs.
Adjustments are made in different regions of the country. There are currently competitive bidding programs in 99 Metropolitan areas throughout the United States, including Honolulu, Hawaii.
The single payment amounts established under this program are also used to set the fee schedule amounts for these diabetic testing supplies when they are picked up at local pharmacies.
In addition, a national mail order program has been implemented for replacement of diabetic testing supplies such as test strips and lancets used with home blood glucose monitors.
Over the past five years, changes to the way CMS pays for durable medical equipment, prosthetics, orthotics and other supplies has saved the federal government over $4 billion over five years.
[Also: Medicare saves over $4 billion in durable medical equipment costs]
Twitter: @SusanJMorse
