On April 29, 2020, the Centers for Medicare & Medicaid Services (CMS)
guidance regarding several emergency waivers
related to Medicare and Medicaid policy and regulatory revisions, which
were originally issued on March 30, 2020, in response to the COVID-19
crisis. The Department of Health and Human Services and CMS very likely
will continue to announce supplemental guidance on the blanket waivers, so
be sure to visit the
McGuireWoods COVID-19: Impact and Insight page for the latest updates.
Below is a summary of the relevant waivers that affect suppliers of durable
medical equipment, prosthetics, orthotics and supplies (DME) and are
intended to equip the American healthcare system with maximum flexibility
to respond to the national emergency. These temporary changes apply
retroactively to March 1, 2020, across the entire U.S. healthcare system
and will remain in effect for the duration of the emergency declaration. By
enacting these waivers, CMS hopes to “put patients over paperwork” to
provide temporary relief from many documentation, reporting, and audit
requirements, so providers and regulators alike can focus on providing
needed care to Medicare and Medicaid beneficiaries affected by COVID-19.
Read on to learn more about the five key waivers applicable to DME
- Replacement of Lost or Damaged DME. Where DME is lost
or damaged, DME Medicare Administrative Contractors (MACs) now have the
flexibility to waive certain replacement requirements typically required by
Medicare. Specifically, CMS indicated that the requirements for a
face-to-face encounter, new physician order, and new medical necessity
documentation, which typically are required to support payment for a
replacement item, are waived for the duration of the COVID-19 national
emergency. CMS cautioned that DME suppliers should still include a
narrative description on the claim explaining why the equipment must be
replaced, and should properly document the loss or damage. CMS made this
documentation waiver retroactive to include dates of service on or after
March 1, 2020.
- Prior Authorization. In light of the COVID-19 pandemic,
CMS is temporarily waiving certain Medicare, Medicaid, and Children’s
Health Insurance Program (CHIP) requirements to relieve the administrative
burden of compliance during the COVID-19 emergency. These agencies
typically require DME suppliers to undergo a prior authorization process to
ensure that applicable coverage, payment, and coding rules are met before
the supplier delivers DME supplies to program beneficiaries. According to
its guidance, CMS is pausing this national prior authorization program for
certain DME suppliers to alleviate administrative burden.
- DME Enrollment and Revalidation. Additionally, CMS is
implementing actions to streamline the DME supplier enrollment process. CMS
has committed to expediting any pending or new applications from DME
suppliers and postponing all supplier revalidations. Based on CMS’
guidance, it is not clear how long the revalidation postponement will last,
but CMS could resume revalidation once the COVID-19 national emergency
ends, if not before. Relatedly, during the COVID-19 emergency, CMS will not
require newly enrolled DME suppliers to become accredited in connection
with the supplier’s enrollment in the Medicare program, and is extending
existing DME supplier accreditations for 90 days.
- DME Payment Increases. As required by the Coronavirus
Aid, Relief, and Economic Security (CARES) Act, CMS will continue to adjust
the fee schedule amounts for items and services furnished in rural and
non-contiguous, non-competitive bidding areas based on a 50/50 blend of
adjusted and unadjusted rates for the remainder of the COVID-19 public
health emergency. Specific to DME suppliers, as required by the CARES Act,
CMS will provide higher payments for certain DME items and services
furnished in non-rural, non-competitive bidding areas within the contiguous
United States with dates of service on or after March 6, 2020, through the
remainder of the COVID-19 public health emergency.
- Signature Requirements. Retroactive to March 1, 2020,
CMS is waiving patient signature and proof-of-delivery
requirements for DME when signatures cannot be obtained because of the
COVID-19 emergency. When this occurs, DME suppliers should document in the
medical record the appropriate date of delivery and indicate that the
signature could not be obtained due to COVID-19. Separately, DME items may
be provided via a physician’s verbal order, although a signature (which may
be electronic) is still required prior to submitting claims for payment.
Please contact the authors or any of the
McGuireWoods COVID-19 Response Team members
for additional information on these waivers. CMS is expected to announce
supplemental guidance on these regulatory changes and McGuireWoods will
continue to monitor COVID-19-related developments and provide updates.
For additional thought leadership on how companies across various
industries can navigate urgent and evolving challenges arising from the
COVID-19 pandemic, visit the
McGuireWoods COVID-19: Impact and Insight page.
In a series of video alerts, McGuireWoods’ healthcare lawyers address
issues providers face and overcoming COVID-19 challenges.