VGM & ASSOCIATESHealthcare MSO
Full Menu Search

The PHE Will End May 11

Published in Government Relations 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.  

TAGS

  1. phe
  2. vgm
  3. vgm government

Get Connected

Stay up-to-date on the latest resources and news provided by VGM & Associates.

Sign Up for Email

From Our Experts

Join HME Industry Letter on CB Program to CMS Administrator Oz thumbnail Join HME Industry Letter on CB Program to CMS Administrator Oz HME suppliers, manufacturers, and distributors are invited to add their company's name to a letter to CMS Administrator Dr. Mehmet Oz regarding the Administration's DMEPOS/Home Health Proposed Rule that includes provisions for a new competitive bidding round. The letter specifically asks CMS to withdraw or delay the DMEPOS provisions in the Proposed Rule and re-engage with industry, patient, and clinical stakeholders to design an evidence-based, fraud-resistant, America-First framework. Take Action Today: Urge CMS to Pause and Re-Evaluate the Competitive Bidding Program thumbnail Take Action Today: Urge CMS to Pause and Re-Evaluate the Competitive Bidding Program Now is the time to raise our voices. With the formal announcement of the Competitive Bidding (CB) Program expected as early as the end of this month, we must act swiftly and decisively. Below are two key opportunities to engage with your U.S. Representative and encourage their support for a Congressional letter urging Centers for Medicare & Medicaid Services (CMS) to pause and reassess the CB Program. Legislative Momentum in the HME Industry: Key Updates & Action Items thumbnail Legislative Momentum in the HME Industry: Key Updates & Action Items The past few months have seen a surge of legislative activity in the home medical equipment sector, with several key developments shaping policy and advocacy efforts across the industry. From new bills introduced in Congress to formal comment submissions and stakeholder mobilization, these events reflect growing momentum around critical issues affecting providers and patients alike. This article offers a comprehensive recap of recent actions and outlines important next steps for those... VGM Submits Comments Regarding the Section 232 National Security Investigation On Medical Imports thumbnail VGM Submits Comments Regarding the Section 232 National Security Investigation On Medical Imports VGM has submitted formal comments to the U.S. Department of Commerce in response to its Section 232 National Security Investigation into the importation of personal protective equipment (PPE), medical consumables, and medical equipment and devices. Senate Backs DME Relief Act with Bipartisan Support thumbnail Senate Backs DME Relief Act with Bipartisan Support In a significant development for the durable medical equipment (DME) industry and Medicare beneficiaries, the U.S. Senate has introduced S.2951, the companion legislation to H.R. 2005, known as the DMEPOS Relief Act of 2025. The Senate bill is being led by Senator James Lankford (R-OK) and has gained bipartisan support with Senator Maggie Hassan (D-NH) joining as a co-sponsor. Gov't Shutdown: What It Means for Providers thumbnail Gov't Shutdown: What It Means for Providers As expected, Democrats and Republican members of the Senate was unable to agree on terms in passing a continuing resolution (CR) ahead of the October 1st deadline, resulting in a government shutdown. But how did we get here? Oppose DMEPOS Bidding Expansion – Take Action Now thumbnail Oppose DMEPOS Bidding Expansion – Take Action Now A critical Congressional Sign-On Letter is now circulating in the House of Representatives, led by Reps. Neal Dunn (R-FL) and Greg Murphy (R-NC). This bipartisan letter calls on CMS to stop the proposed expansion of the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Competitive Bidding Program to include ostomy and urological supplies. Gov't Shutdown & Telehealth Flexibility Expiration thumbnail Gov't Shutdown & Telehealth Flexibility Expiration September 30 represents an important date for HME providers for two reasons: 1) The potential of a government shutdown and how that affects HHS and CMS, and 2) the expiration of Telehealth Flexibilities unless a Continuing Resolution (CR) is agreed upon in time.

Give your business an advantage over the competition.

Become a Member