The PHE Will End May 11

Published in Orthotics & Prosthetics on January 31, 2023

President Biden has announced that the COVID-19 Public Health Emergency (PHE) will officially end on May 11, 2023. This PHE was initially announced in early 2020 and has been renewed in multiple 90-day increments since then, most recently on Jan. 11.

What Ending the PHE Means for DMEPOS Suppliers

There are several provisions which impact the DMEPOS industry tied to the duration of the PHE. With the official ending of the PHE now in sight, most of those provisions and waivers that are still in place will end on May 11, 2023. Those waivers impacted signature/documentation requirements, reimbursement methodology, and modified medical policies (LCD), etc. A full list of all waivers can be found here, and the waivers specific to DMEPOS suppliers can be found here.

For those beneficiaries that received equipment with a waiver, we are still awaiting direction from CMS. When we met with CMS in the past to share concerns regarding patients in the post-PHE transition, CMS representatives indicated they would provide ample time with instruction. Once we receive this direction from CMS and the local DME MACs, we will provide the information to the supplier community.

In the meantime, start running reports in your billing software looking for those claims with the CR modifier and claim narrative (COVID-19). Know the status of those beneficiaries and claims in preparation for any instruction we shall receive.

Regarding the 75/25 blended reimbursement rates for providers serving Medicare beneficiaries in non-rural, non-competitive bid areas, these rates will not expire with the PHE, as first intended. Introduced and implemented by CMS after the passage of the CARES Act in March 2020, these increased reimbursement rates were initially tied to the PHE, meaning they would go away as soon as the PHE was officially ended. However, the Omnibus bill passed at the end of 2022 ensured that those 75/25 blended rates would remain in place through the end of 2023 if the PHE ended during 2023.

That means that reimbursement for DMEPOS providers will be as follows:

Providers serving Medicare beneficiaries located within CBAs will continue to receive the CBA rates (the higher blended rates were never applied in these areas).
Providers serving Medicare beneficiaries located in non-rural, non-competitive bid areas will receive the 75/25 blended rates for dates of service up to and including Dec. 31, 2023. On Jan. 1, 2024, those blended rates will end, and reimbursement will revert to rates similar to what was in place prior to the PHE. Those pre-pandemic rates, however, will be adjusted based on the CPI-U increases for 2022 (between 5.1 and 5.4%) and 2023 (between 6.4 and 9.1%).
Providers serving Medicare beneficiaries in rural areas will continue to receive the 50/50 blended rates indefinitely. These rural rates have been in place since 2018, prior to the PHE declaration, and will remain in effect until further rulemaking changes them. They will not end when the PHE does, nor will they end on Dec. 31, 2023, with the 75/25 blended rates.

As always, the experts in VGM Government Relations will continue to monitor the changes and updates and communicate additional details as needed. Feel free to contact us with any questions related to this topic.

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