Updates on the PHE, Vaccine Mandates, & DMEPOS Master List

It has been a busy month! There are several updates that directly impact the DME industry; it includes the current COVID-19 Public Health Emergency (PHE) extension, vaccine mandates, and changes to the Master List of DMEPOS items. Make sure to read all the information below to learn how these updates could impact your business.

PHE Extension Until April 2022

On Sunday, January 16, 2022, the COVID-19 PHE was extended until April 16, 2022. This extension significantly benefits DME providers in six different areas.

1. 75/25 Blended Rate Extended 

This blended rate in non-rural and non-CB areas will remain in effect until April 16, 2022.

2. Continue with National and Local Coverage Determination Flexibility 

Providers can continue to expand the use of home-based respiratory products and therapy and infusion and anticoagulation devices for both NCD/LCD.

3. Continue with Waived Face-to-Face Requirements

Suppliers can continue to use telehealth visits to supply DME items that normally require face-to-face meetings.

4. Federal Medical Assistance Percentage (FMAP) Increase 

The Medicaid FMAP match will increase to 6.2% through the end of June 2022 (the rule allows the effect to last until the end of the PHE quarter). 

 5. Medicaid Waivers and Flexibilities Continue 

All-State Medicaid waivers and flexibilities connected to the PHE will continue. However, individual states can choose to end their state-granted flexibilities sooner if they prefer.

6. TRICARE Increases

Any TRICARE reimbursements connected to Medicare’s rate relief will continue to increase. 

OSHA Vaccine Mandate Blocked While CMS Vaccine Mandate Continues 

Several vaccine mandates have impacted DME providers since Fall 2021. The good news, the US Supreme Court blocked the enforcement of the Occupational Safety and Health Administration’s (OSHA) mandate. While the Centers for Medicare and Medicaid Services (CMS) Interim Final Rule is being upheld by the US Supreme Court. 

How will the CMS’s Vaccine Mandate Impact DME Owners?

In a January 13 statement, CMS announced that their COVID-19 vaccine mandate is now reactivated in all 50 states following the US Supreme Court’s decision. The good news is that DMEPOS suppliers aren’t included in the CMS mandate. However, if you have staff working on behalf of a health care provider that falls under this mandate, they will need to comply.

DMEPOS Master List & Prior Authorization List Updates 

Last week, CMS updated their lists regarding all DMEPOS items that could require face-to-face encounters along with written orders and prior authorizations before delivery. You can read all three lists (Master, Required Prior Authorization, and Required Face-to-Face Encounter and Written Order Prior to Delivery) here

Current Impact on Suppliers 

As of right now, there’s no direct impact on DME suppliers as CMS continues to add and remove supplies from the lists. It’s necessary to note that any item included on the Master List might be added to the Required Prior Authorization or Required Face-to-Face Encounter and Written Order Prior to Delivery lists. You’ll be aware of any changes before it occurs since CMS is required to announce changes to the Federal Register first.

11 New Codes to the Required Prior Authorization List

CMS is adding 11 codes to the Authorization List. It includes six Power Mobility Device (PMD) codes and five orthoses codes. 

The PMD codes will go into effect nationwide on April 13, 2022. In comparison, there is a three-phase plan to implement the five orthoses codes to all 50 states. The phases are listed below.

Implementing Phase 1 on April 13, 2022

  • California
  • Florida
  • Illinois 
  • New York

Implementing Phase 2 on July 12, 2022

  • Maryland
  • Pennsylvania
  • New Jersey
  • Michigan
  • Ohio
  • Kentucky
  • Texas
  • North Carolina
  • Georgia
  • Missouri
  • Arizona
  • Washington

Implementing Phase 3 on October 10, 2022

  • Nation-wide

Thanks to AAHomecare for providing the industry with a detailed summary of the above information. You can read it here.

Follow Medbill for all 2022 Industry Changes

Our team regularly monitors industry news and changes that could impact DME owners, so you have access to the latest information when it’s available. In addition, you can follow our news page, Facebook, Twitter, or LinkedIn accounts so you can read our latest articles. 

Contact us if you have questions about the above changes or want to learn more about our DME billing services.