New CMS Proposals to Modernize and Drive Innovation in Durable Medical Equipment and End-Stage Renal Disease Programs
Combined actions would increase access to durable medical equipment, reduce administrative burden, and encourage development of innovative therapies for beneficiaries on dialysis.
Today, the Centers for Medicare & Medicaid Services (CMS) proposed innovative changes to the payment rules for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) program. The DME proposals in the proposed rule released today aim to increase access to items for patients and simplify Medicare’s DMEPOS Competitive Bidding Program (CBP) to drive competition and increase affordability. The rule also includes ESRD proposals, including a proposal to address new renal dialysis drug and biological costs and foster innovations in treatment by incentivizing new therapies for patients on dialysis and a proposal to reduce facility-related documentation burden.
“At CMS, we celebrate innovation in the healthcare system and encourage new therapies that will help save lives and lower costs for patients,” said CMS Administrator Seema Verma. “Today’s proposals will help secure sustainable access to durable medical equipment and reward dialysis facilities that adopt innovative new therapies.”
Today’s proposed rule takes key steps towards changing Medicare’s DME fee schedule payments and the DMEPOS CBP. A successful CBP for DME is important for the Medicare program, but many stakeholders have raised concerns about beneficiary access to items and services under the current CBP. CMS sought ways to improve competitive bidding going forward and worked with market experts to leverage opportunities to increase the program’s effectiveness. Today’s rule proposes market-oriented reforms to the DMEPOS CBP. The process for recompeting contracts with suppliers currently in effect under the DMEPOS CBP has not yet been initiated. As a result, we note that the current contracts for the DMEPOS CBP will expire on December 31, 2018. Beginning January 1, 2019, and until new contracts are awarded under the DMEPOS CBP, beneficiaries may receive DMEPOS items from any Medicare enrolled DMEPOS supplier.
As required by the 21st Century Cures Act, this rule also includes proposals that address Medicare fee schedule payments for DME furnished on or after January 1, 2019 in areas of the country where competitive bidding is not in effect. The proposed rule also solicits stakeholder feedback on CMS’ approach to establishing the fee schedule amounts for new DME technologies. These improvements will modernize the Medicare DME program.
CMS is also taking steps today to promote innovation in Medicare’s ESRD PPS by expanding the ESRD Transitional Drug Add-on Payment Adjustment (TDAPA) to encourage the use of new drug therapies by promoting innovation in the program in order to encourage the development and use of new treatments and therapies. As the largest payer for kidney care, we recognize that Medicare has a large part to play in encouraging innovation in an area where innovation has been lagging.
We are proposing to make changes to Medicare’s payment structure that will support access to new renal dialysis drugs and foster innovation in this critical area of heath care.
This proposed rule also takes significant steps forward by strengthening quality incentives and reducing administrative burden. Based on stakeholder feedback, CMS intends to reduce ESRD facility-related documentation burdens for certain payment adjustments so that requirements are more consistent with other payment systems. These changes will allow doctors to spend less time on paperwork and more time with their patients, which is in line with CMS’ Patients Over Paperwork initiative. Also, CMS is proposing to update the measure set for the ESRD QIP so that it is more closely aligned with the quality priorities the agency has adopted as part of the Meaningful Measures Initiative.
For a fact sheet on the CY 2019 proposed rule (CMS-1691-P), please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-11.html
To view the proposed rule, please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14986.pdf.