The Centers for Medicare & Medicaid Services has proposed policy changes that would establish new methodologies for adjusting fee schedule payment amounts for Medicare durable medical equipment, prosthetics, orthotics, and supplies furnished in non-competitive bidding areas.
The proposed rule also would expand the interpretation of the appropriate for use in the home requirement within the definition of DME, specifically for external infusion pumps with the goal of increasing access to home infusion drugs.
The proposal, the agency said, aims to provide more choices for beneficiaries who have diabetes while also streamlining the process for innovators to have their technologies approved for coverage, payment and coding by the Medicare program.
“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,” CMS Administrator Seema Verma said.
U.S. Sen. Susan Collins (R-ME), founder and co-chair of the Senate Diabetes Caucus, applauded the proposed rule change for its expanded Medicare Part B coverage and payment policies, which would classify all (not just therapeutic) continuous glucose monitors as durable medical equipment. Collins said that the move builds on Medicare’s 2017 decision to provide coverage for certain CGMs advocated by her and U.S. Sen. Jeanne Shaheen (D-NH).
