Proposed Rule Changes would Streamline Medicare Services and Provide Diabetes Patients with more Therapy Choices

On October 27, aligning with President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors, CMS proposed changes to the Medicare Durable Medical Equipment, Prosthetics, Orthotic  Devices, and Supplies (DMEPOS) coverage and payment policies. The proposed rule would provide more options to beneficiaries with diabetes and allow them to receive their supplies or services quicker and would greatly reduce administrative burdens. Additionally, it would streamline the coverage, coding, and payment process for approving those technologies. A process that currently takes six months could be completed on the same day the billing codes payment goes into effect.

CMS Administrator Seema Verma said, “With the policies outlined in this proposed rule, innovators have a much more predictable path to understanding the kinds of products that Medicare will pay for (and) for manufacturers, bringing a new product to market will mean they can get a Medicare payment amount and billing code right off the bat, resulting in quicker access for Medicare beneficiaries to the latest technological advances and the most, cutting-edge devices available.” 

Furthermore, this proposed rule would expand Medicare’s coverage and payment for Continuous Glucose Monitors (CGMs). At the present time, CMS will only cover FDA-approved or therapeutic CGMs. By classifying all CGMs as DME, CMS will be able to set up payment amounts for CGMs and similar items. This will provide Medicare beneficiaries currently diagnosed with diabetes more options in managing their disease. When CGMs are not used for making diabetes treatment decisions, they can be used to alert beneficiaries when they reach potentially dangerous glucose levels, even as they sleep. 

This proposal would expand the classification of external infusion pumps that can be covered as DME under Medicare Part B. An external infusion pump delivers nutrients and medications, in a controlled manner, to a patient’s body. This would allow the beneficiary to have the option to be treated at home, not just at a health care facility. 

Based on stakeholder feedback, CMS will continue to pay suppliers higher amounts for DMEPOS items and services. This will help beneficiaries who live in rural and non-contiguous areas still have access to those items and services. This is due to the challenges and costs associated with providing DMEPOS in those areas. 

For further information on this proposed rule, visit the below pages. 

Proposed Rule Information – https://www.cms.gov/files/document/cms-1738-p-dmepos.pdf 

Fact Sheet on the DMEPOS Level II Proposed Rule – https://www.cms.gov/newsroom/fact-sheets/medicare-cy-2021-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos-policy-issues