Moving the HME Industry Forward

Legislative/Advocacy

CMS Provides Updates on Provisions in 21st Century CURES Legislation

January 2, 2017

WASHINGTON, DC – On Friday, CMS updated its Durable Medical Equipment Center page with information on implementing provisions in the CURES bill signed into law earlier this month.

The update covers the additional 6-month delay to the application of bidding-derived pricing reductions for complex rehab technology accessories used with Group 3 power wheelchairs, as well as retroactive relief for the second phase of bidding-derived cuts for rural and non-bid area providers from July 1 through Dec. 31, 2016.

In the case of the relief for rural and non-bid providers, the key takeaway is noted at the end: “CMS is currently working to implement this section and will be providing contractor instructions for re-processing the applicable claims. There is no action required for the suppliers at this time. Formal instructions will be issued in the near future.”

Text of CMS’ full update is shown below (headings and emphasis ours).

Delay of Bidding-derived Pricing for Complex Rehab Accessories
Section 16005 of the 21st Century Cures Act extends the PAMPA provisions of unadjusted fee schedules for Group 3 wheelchair accessories and cushions used with Group 3 complex rehabilitative power wheelchairs through June 30, 2017.

To implement the extension, the 2016 KU fee schedule amounts have been updated by the 2017 0.7 percent covered item update and will be added to the 2017 DMEPOS fee schedule file. Suppliers should continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs with dates of service January 1, 2017 through June 30, 2017.

Relief for Rural and Non-bid Area Providers
In addition, Section 16007 of the 21st Century Cures Act extends the transition period for the 50/50 blend of unadjusted and adjusted fees for competitive bid items in non-competitive bid areas. The law requires that adjustments be made to the fee schedule amounts for certain items furnished on or after January 1, 2016 in areas that are not competitive bid areas, based on information from competitive bidding programs (CBPs).

The fee schedule adjustments were phased in for claims with dates of service January 1, 2016 through June 30, 2016, so that each fee schedule amount was based on a blend of 50 percent of the fee schedule amount that would have gone into effect on January 1, 2016, if not adjusted based on information from the CBP, and 50 percent of the adjusted fee schedule amount. Section 16007 of the Cures Act extends this transition period from June 30, 2016 to December 31, 2016 with the full implementation of the 100 percent adjusted fee schedule amounts applying on or after January 1, 2017. CMS is currently working to implement this section and will be providing contractor instructions for re-processing the applicable claims. There is no action required for the suppliers at this time. Formal instructions will be issued in the near future.