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Mass Adjustments From CARES Act For NON-RURAL Areas

Part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act included reimbursement rate changes for certain zip codes and HCPCS codes.

Let’s start with the rural and contiguous areas where the 50/50 blended rate that was initially set to expire December 31, 2020 and is now being extended beyond 2020 and for the duration of the public health emergency (PHE). This applies to beneficiaries that have a rural zip code according to Medicare FFS and the HCPCS code is part of the former Competitive Bid program (CBP), does not apply to all HCPCS codes.

The beneficiaries that have a zip code in what is considered a Non-Rural and noncontiguous areas will are getting the 75/25 blended rate increase. That is 75% of the adjusted rates and 25% of the 2015 unadjusted rates. These rates will be retroactive as of March 6, 2020 through the remainder of the duration of public health emergency period.

Suppliers started seeing these non-rural rate increase in the non-rural zip codes mid-April (around April 22nd). For those dates between March 6th and April 22nd (about 51 days) there will be a mass adjustment.  Meaning suppliers should not have to do anything at this time. Again, this applies to beneficiaries that have non-rural zip code according to Medicare FFS and this is for HCPCS codes that are part of the former Competitive Bid program (CBP).

As of right now, we are waiting on more details as to when the mass adjustment will take place and the process. We do know the DME MACs have been meeting to work out the details and they are awaiting on CMS for some final instructions. We would suspect this mass adjustment for the non-rural zip codes to occur fairly soon.

If you service beneficiaries in the former competitive bid areas (CBAs), these areas will not have an increase in reimbursement. This was not part of the CARES Act. This means the single payment amounts (SPAs) available today in those former CBAs are to remain unchanged at this time.

We at VGM continue to watch for the details to be released by the DME MACs. As soon as we learn more, we will be sharing with our members.

To read the MLN article discussing the CARES Act rate adjustments, please refer to the link below for MLN MM11784.



Ronda Buhrmester                                                    Dan Fedor
VGM Group                                                               US Rehab division of VGM
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