{"id":10318,"date":"2025-12-01T12:08:24","date_gmt":"2025-12-01T17:08:24","guid":{"rendered":"https:\/\/www.appliedpolicy.com\/staging\/7403\/?p=10318"},"modified":"2025-12-01T12:08:24","modified_gmt":"2025-12-01T17:08:24","slug":"cms-finalizes-rule-on-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos-competitive-bidding-program-without-major-changes","status":"publish","type":"post","link":"https:\/\/www.appliedpolicy.com\/staging\/7403\/cms-finalizes-rule-on-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos-competitive-bidding-program-without-major-changes\/","title":{"rendered":"CMS Finalizes Rule on Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Without Major Changes"},"content":{"rendered":"<p>On November 28, 2025, the Centers for Medicare &amp; Medicaid Services (CMS) released <a href=\"https:\/\/www.federalregister.gov\/public-inspection\/2025-21767\/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-rate-update\">Calendar Year<\/a> <a href=\"https:\/\/www.federalregister.gov\/public-inspection\/2025-21767\/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-rate-update\">(CY) 2026 Home Health Prospective Payment System and Durable Medical Equipment, Prosthetics,<\/a> <a href=\"https:\/\/www.federalregister.gov\/public-inspection\/2025-21767\/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-rate-update\">Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) Final Rule. <\/a>CMS released a <a href=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/durable-medical-equipment-prosthetics-orthotics-supplies-competitive-bidding-program-updates#_ftn1\">fact<\/a> <a href=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/durable-medical-equipment-prosthetics-orthotics-supplies-competitive-bidding-program-updates#_ftn1\">sheet<\/a> accompanying the \ufb01nal rule. This summary is speci\ufb01cally on provisions related to DMEPOS sections of the \ufb01nal rule, which mostly re\ufb02ect the policies laid out in the proposed rule.<\/p>\n<p>CMS \ufb01nalizes the following provisions:<\/p>\n<ul>\n<li>Create a new remote item delivery competitive bidding program,<\/li>\n<li>Reclassify continuous glucose monitors and insulin pumps to the frequent and substantial servicing payment category,<\/li>\n<li>Establish new methodology for determining single payment amounts for lead items in a competitive bid product category,<\/li>\n<li>Update certain CBP bid processes,<\/li>\n<li>Add new items to CBP, including urological and ostomy supplies,<\/li>\n<li>Update DMEPOS provider enrollment,<\/li>\n<li>Update DMEPOS supplier accreditation process, and<\/li>\n<li>Establish a process to exempt DMEPOS suppliers from prior authorization of certain DMEPOS<\/li>\n<\/ul>\n<p>In the fact sheet, CMS announces a goal timeline for the implementation of the new CBP as no later than January 1, 2028. CMS also states that there will be a 6-month transition period for bene\ufb01ciaries to switch suppliers.<\/p>\n<p><strong>This<\/strong> <strong>\ufb01nal<\/strong> <strong>rule<\/strong> <strong>is<\/strong> <strong>scheduled<\/strong> <strong>to<\/strong> <strong>be<\/strong> <strong>published<\/strong> <strong>in<\/strong> <strong>the<\/strong> <strong><em>Federal<\/em><\/strong> <strong><em>Register<\/em><\/strong> <strong>on<\/strong> <strong>December<\/strong> <strong>2,<\/strong> <strong>2025.<\/strong><\/p>\n<h3>CMS TO CREATE REMOTE ITEM DELIVERY (RID) CBPFOR CERTAIN HIGH VOLUME ITEMS <em><span style=\"color: #339966;\">FINALIZED AS PROPOSED-<\/span><\/em> Page 527<\/h3>\n<p>CMS \ufb01nalizes that items generally furnished from remote supplier locations should be included under a \u201cremote item delivery\u201d CBP or RID CBP. According to CMS, Medicare claims data shows several high-volume categories of items are furnished to bene\ufb01ciaries throughout the nation from remote supplier location. CMS calculated that the average distance between the bene\ufb01ciary address and the supplier locations is several hundred miles for lead items in high-volume categories of items. As such, rather than implementing hundreds of local competitive bidding contracts and competitive bidding areas,<\/p>\n<p><strong>CMS \ufb01nalizes creating a nationwide RID CBP or several large regional RID CBPs for several new product categories.<\/strong><\/p>\n<p>In this rule, CMS does not determine which speci\ufb01c areas would be included under a RID CBP. However, if regional RID CBPs are established, these areas could cover smaller regions such as a State, territory, or the District of Columbia, or they could cover larger areas such as a group or combination of States, territories, and\/or the District of Columbia.<\/p>\n<p>In its fact sheet, CMS lists the product categories that could be included under the RID CBP. These include:<\/p>\n<ul>\n<li>Class II Continuous Glucose Monitors (CGMs)and Insulin Pumps<\/li>\n<li>Urological Supplies<\/li>\n<li>Ostomy Supplies<\/li>\n<li>Hydrophilic Urinary Catheters<\/li>\n<li>Off-The-Shelf (OTS) Back Braces<\/li>\n<li>OTS Knee Braces<\/li>\n<li>OTS Upper Extremity Braces<\/li>\n<\/ul>\n<p>CMS also lists the speci\ufb01c Healthcare Common Procedure Coding System (HCPCS) codes within each product category that may be included in the RID CBP<a href=\"applewebdata:\/\/DAD551DB-163F-4026-A9D0-00152A79C587#_ftn1\" name=\"_ftnref1\">[1]<\/a> but caveats that this table is for illustration purposes only. CMS states that the actual products included in each category will be designated through program instructions.<\/p>\n<p>Contract suppliers will have the option to furnish these items on a non-mail order basis as well as on a mail-order basis, but would be required to furnish the items on a non-mail order basis.<\/p>\n<p>Under \u00a7 414.402, the term \u201cRemote item delivery competitive bidding program\u201d will be de\ufb01ned as \u201ca competitive bidding program wherein contract suppliers are responsible for furnishing remote item delivery items under the product category primarily to all Medicare bene\ufb01ciaries regardless of where they live in the CBA. The CBA could be one nationwide CBA that includes all areas (all States, territories, and the District of Columbia) or a CBA covering a speci\ufb01c region of the country.\u201d<\/p>\n<p>\u201cRemote item delivery item\u201d would be de\ufb01ned as \u201citem falling under a remote item delivery competitive bidding program that may be shipped or delivered to a bene\ufb01ciary\u2019s home, regardless of the method of delivery or picked up at a local pharmacy or supplier storefront if the bene\ufb01ciary or caregiver for the bene\ufb01ciary chooses to pick the item up in person.\u201d In order for a bene\ufb01ciary to pick up the item in person at a local storefront, that supplier would be required to be a contract supplier for the time.<\/p>\n<p>In response to the concerns that RID CBP would cause smaller DME suppliers to close, CMS states that it will aim to award at least 30 percent of the total number of contracts to small suppliers. This response seems to be at odds with the requirements and demand a supplier would have to meet in order to provide a product category to bene\ufb01ciary nationwide.<\/p>\n<p>With regards to concerns over state licensure requirements, CMS states that all suppliers would be required to have state\/territory licensure for the regional area for which they submit bids by the close of the bid window. In addition, CMS states that it is up to the supplier to con\ufb01rm licensure requirements with states.<\/p>\n<h3>CMS WILL RECLASSIFY ALL CONTINUOUS GLUCOSE MONITORS AND INSULIN INFUSION PUMPS INTO A NEW PAYMENT CATEGORY AND INCLUDE THEM IN CBP <em><span style=\"color: #339966;\">FINALIZED AS PROPOSED- Page 565-566<\/span><\/em><\/h3>\n<p><span style=\"color: #339966;\"><strong>CMS \ufb01nalizes<\/strong> <strong>its<\/strong> <strong>proposal<\/strong> <strong>to reclassify<\/strong> <strong>all<\/strong> <strong>continuous glucose monitors<\/strong> <strong>(CGMs) and<\/strong> <strong>insulin infusion <\/strong><\/span><strong><span style=\"color: #339966;\">pumps under the frequent and substantial servicing payment category under \u00a7 414.222(a) and to pay for these on a monthly rental basis under the DMEPOS CBP and in non-CBAs under the fee schedule payments.<\/span> <\/strong>The monthly rental payment includes payment for the base durable medical equipment item and associated supplies and accessories. CMS will allow contract suppliers to bill for up to 3 months of rental for these items in advance.<\/p>\n<p><strong>This is a major shift from how CGMs and insulin pumps are currently paid under the Medicare Part B DME bene\ufb01t<\/strong>. Currently, Medicare bene\ufb01ciaries receive a replacement CGM receiver or insulin pump once every 5 years, unless their equipment is lost, stolen or irreparably damaged. CMS states that CGM and insulin pump technology will rapidly change in future years and is concerned that the current bene\ufb01t limits bene\ufb01ciary choice and access to newer rapidly changing technology. Under the current DME bene\ufb01t, CGM receivers are classi\ufb01ed as a routinely purchased equipment where Medicare makes a one-time payment for purchase, and insulin pumps are classi\ufb01ed as a capped rental item where Medicare makes payments for 13 months after which the bene\ufb01ciaries assumed ownership of the pump.<\/p>\n<p>By \ufb01nalizing the reclassi\ufb01cation of CGMs and insulin pumps to the frequent and substantial servicing category, <strong>CMS eliminates bene\ufb01ciary ownership of CGMs and insulin pumps for new patients<\/strong>; but allows bene\ufb01ciaries \ufb02exibility to switch to a new technology more often than once every 5 years. <strong>CMS <\/strong><strong>did not propose criteria under which a contract supplier would be required to upgrade a bene\ufb01ciary to a new CGM or insulin pump<\/strong>&#8211; <strong>except that the bene\ufb01ciary would request such an upgrade.<\/strong> CMS states that the contract supplier of the rented CGM and insulin pump will be responsible for software updates for the equipment and performing any necessary maintenance and servicing of the equipment, as well as addressing recalls and replacing recalled equipment.<\/p>\n<p><strong>All<\/strong> <strong>CGMs<\/strong> <strong>and insulin<\/strong> <strong>pumps will be<\/strong> <strong>classi\ufb01ed as items requiring frequent and<\/strong> <strong>substantial servicing beginning<\/strong> <strong>on<\/strong> <strong>the<\/strong> <strong>date<\/strong> <strong>class<\/strong> <strong>II<\/strong> <strong>CGMs<\/strong> <strong>and<\/strong> <strong>insulin<\/strong> <strong>pumps<\/strong> <strong>are<\/strong> <strong>\ufb01rst<\/strong> <strong>phased<\/strong> <strong>in<\/strong> <strong>under<\/strong> <strong>the <\/strong><strong>DMEPOS<\/strong> <strong>CBP.<\/strong><\/p>\n<p><strong>Payment Based on Monthly Rental Basis<\/strong><\/p>\n<p>CMS establishes payment for CGMs and insulin pumps by adding up the current monthly fee schedule amounts for the base DME item and the supplies. For the base items, using 5-year reasonable lifetime requirement as a reference, CMS \ufb01nalizes its proposal to divide the total fee schedule amount by 60 for the number of months over a 5-year period. This leads to the following bid limits, based on the 2025 DME fee schedule:<\/p>\n<p><strong>CGMs: $272.69<\/strong><\/p>\n<ul>\n<li>Monthly fee schedule for CGM supplies (A4239): $267.92<\/li>\n<li>Purchase fee schedule amount for CGM receiver (E2103): $286.03 \u2013 when divided by 60 generates a monthly payment of $4.77<\/li>\n<li>$267.92+$4.77= $272.69<\/li>\n<\/ul>\n<p><strong>Insulin pumps: $226.22<\/strong><\/p>\n<ul>\n<li>Monthly fee schedule for infusion set supplies (A4224):$25.19 x 4 per month=$100.76<\/li>\n<li>Monthly fee schedule for insulin cartridges (A4225):$3.38 x 9 per month= $30.42\n<ul>\n<li>CMS states that in 2024, Medicaid paid for 7-9 units of A4225 per month on average and that is why the insulin cartridge rate (per unit) is multiplied by CMS is seeking specific comments on the number of units to use for one-month supply.<\/li>\n<\/ul>\n<\/li>\n<li>Monthly fee schedule for insulin pump(E0784):$5,702.34\/60months= $95.04<\/li>\n<li>$95.04+$30.42+$100.76 = $226.22<\/li>\n<li>CMS uses the nonrural payment amounts in the current fee schedule, stating that the cost of shipping an item from a remote location to a bene\ufb01ciary residing in a rural area is typically no higher than the cost of shipping an item from a remote location to a bene\ufb01ciary residing in a nonrural area.<\/li>\n<\/ul>\n<p><strong>Additionally, CMS states that CGMs and insulin pumps would be included in the same competitive bid product category, but does not determine whether the CGM or the insulin pump would be the lead item for the category.<\/strong><\/p>\n<p>Class III devices are statutorily excluded from the DMEPOS CBP per section 1847(a)(2)(A) of the Act. Insulin pumps used in conjunction with class III CGMs would also be excluded from the DMEPOS CBP. However, CMS \ufb01nalizes its proposal to make equal the payment for class II and class III CGMs and insulin pumps if the payments for class III CGMs and insulin pumps used in conjunction with class III CGMs are more than 15 percent higher than the amounts established for the class II CGMs and insulin pumps under the DMEPOS CBP.<\/p>\n<p>Bidding entities competing to be nationwide contract suppliers for these items and other items in the same product category would need to submit bids that are lower than the bid limit to be considered. CMS will determine single payment amounts for lead and non-lead items in a product category after evaluating all the bids it receives from bidding entities<strong>.<\/strong><\/p>\n<p>For bene\ufb01ciaries who own their insulin pump, coinsurance would remain relatively the same for monthly supplies when the new rules go into e\ufb00ect. For bene\ufb01ciaries who are in the middle of the 13- month capped rental period, their coinsurance would increase as they transition to the new monthly payments which would not be reduced by the amounts attributed to the monthly rental payments already made under the capped rental rules.<\/p>\n<p>Suppliers with existing rental agreements in place at the time CBP is implemented will be grandfathered as non-contract suppliers until the bene\ufb01ciary requires or requests a new device. The noncontract suppliers will be paid based on the monthly rental amounts established under DMEPOS CBP.<\/p>\n<p>During the public comment process, the diabetes industry, including patient and advocacy organizations, <a href=\"https:\/\/www.appliedpolicy.com\/staging\/7403\/stakeholders-await-decision-on-competitive-bidding\/\">strongly opposed<\/a> the inclusion of CGMs and insulin pumps in the CBP and the reclassi\ufb01cation of these products into the frequent and substantial servicing payment category. However, CMS disagreed with the majority of the concerns raised by stakeholders and \ufb01nalized the new policies largely as proposed.<\/p>\n<h3>CMS FINALIZES ADDING ITEMS CONSIDERED MEDICAL SUPPLIES TO CBP <em><span style=\"color: #339966;\">FINALIZED AS PROPOSED- Page 503<\/span><\/em><\/h3>\n<p>Despite <a href=\"https:\/\/mcusercontent.com\/3c0f3755f13930464597f245a\/files\/35d47d7d-cc75-d019-4116-1a3826aae938\/AAH_CMS_1828_P_DME_Comments_08_25_FIN.pdf\">backlash from stakeholders<\/a> that CMS has exceeded its authority, CMS \ufb01nalizes its proposal to include urological and ostomy supplies in the RID CBP. CMS is proposing to include ostomy, tracheostomy, and urological supplies to the de\ufb01nition of \u201cmedical equipment items\u201d. Speci\ufb01cally, this includes home health medical supplies such as intermittent catheters, catheter supplies, ostomy bags, supplies related to ostomy care, and certain covered osteoporosis drugs. These items are currently covered under the prosthetic bene\ufb01t under Medicare Part B and have previously been excluded from CBP as a result. By reinterpreting the statute, CMS believes these items are included in the de\ufb01nition of \u201cmedical equipment\u201d and therefore can be included in CBP. Given the strong comments regarding this proposal, it is possible there will be a legal challenge from stakeholders.<\/p>\n<h3>BACKGROUND ON THE COMPETITIVE BIDDING PROGRAM<\/h3>\n<p>The primary goal of the DMEPOS CBP is to save the Medicare program money by reducing excessive payments for items and services by awarding contracts to a certain suppliers with the lowest bid amounts and who have the capacity to furnish items needed in each competitive bidding area (CBA). Per statute, in order for CBP to be implemented, the total amounts to be paid to CBP contract suppliers in an area must be less than the total amounts that would have otherwise been paid under the DMEPOS fee schedule. In other words, CBP must save the program money or CMS cannot implement CBP in the speci\ufb01c area where there are no savings. CMS also believes that CBP prevents supplier fraud because it decreases the incentive to commit fraud by lowering the allowed amounts paid for items.<\/p>\n<h3>CMS FINALIZES CHANGES TO ESTABLISHING SINGLE PAYMENT AMOUNTS AND UPDATES TO CBP PROCESSES <em><span style=\"color: #339966;\">FINALIZED AS PROPOSED- Page 476<\/span><\/em><\/h3>\n<p>CMS establishes a \ufb01xed payment amount known as the single payment amount (SPA) for a particular item in a CBA after the bidding process is complete. In the most recent round of CBP, CMS set the SPA for the lead item in a product category at the highest winning bid amount for that item within the CBAs. SPAs for non-lead items in the same product category were then calculated based on the lead item\u2019s SPA.<\/p>\n<p>CMS \ufb01nalizes the following modi\ufb01cations to the CBP:<\/p>\n<ul>\n<li>Lower number of suppliers: process for selecting the number of contract suppliers sufficient to furnish items and services in a competition<a href=\"applewebdata:\/\/DAD551DB-163F-4026-A9D0-00152A79C587#_ftn2\" name=\"_ftnref2\">[2]<\/a><\/li>\n<li>Methodology for establishing SPAs for lead and non-lead items: <strong>Single payment amount for a lead item furnished under the competitive bidding program will be <\/strong><strong>equal<\/strong> <strong>to<\/strong> <strong>the<\/strong> <strong>75th<\/strong> <strong>percentile<\/strong> <strong>of<\/strong> <strong>bids<\/strong> <strong>instead<\/strong> <strong>of<\/strong> <strong>the<\/strong> <strong>maximum<\/strong><\/li>\n<li><strong>Supplier Capacity: <\/strong>Supplier capacity will be estimated using data on actual contract supplier capacity from previous rounds of DMEPOS CBP.<\/li>\n<li><strong>Documentation Required<\/strong><strong> for Bidding Entities: <\/strong>Reduce the number of documents that bidding entities are required to submit during the bid window by no longer requiring the submission of a tax return extract, income statement, balance sheet, and statement of cash Instead, CMS will only require bidding entities to submit a business credit report.<\/li>\n<li><strong>Codify<\/strong> <strong>Surety<\/strong> <strong>Bond<\/strong> <strong>Requirements:<\/strong> Codify certain requirements for bid surety<\/li>\n<\/ul>\n<p>For new categories added to the CBP, the number of contract suppliers needed to furnish items and services would be at least 2 and no more than 125% of the number of suppliers that furnished at least 3% of the total utilization for the lead item in the product category and CBA during the most recent calendar year.<\/p>\n<p>To help bidders provide more certainty in their bids, CMS will apply an annual in\ufb02ation update when appropriate to help account for unforeseen changes (i.e. public health emergency, in\ufb02ation). The inflation would be equal to the percentage change in the Consumer Price Index for all Urban Consumers (CPI-U) of the prior year. CMS also states that if there is a public health emergency (PHE), items and services in a PHE-impacted area are immediately terminated or modi\ufb01ed so that DMEPOS can be sent to the PHE-impacted area.<\/p>\n<p>CMS \ufb01nalizes that it will not award a contract under the DMEPOS CBP if the total amount paid under the program is greater than all payments that would otherwise be made.<\/p>\n<h3>CMS FINALIZES CHANGES TO MEDICARE AND MEDICAID PROVIDER ENROLLMENT POLICIES <em><span style=\"color: #339966;\">FINALIZED AS PROPOSED \u2013 pages 268, 273, 275, 277, 279, 281, 284, 286<\/span><\/em><\/h3>\n<p>CMS \ufb01nalizes several changes to existing Medicare provider enrollment regulations and a change to Medicaid provider enrollment provisions.<\/p>\n<p><strong>Medicare Provider Enrollment Provisions<\/strong><\/p>\n<p>Currently, if the provider or supplier certi\ufb01ed misleading or false information on their enrollment application as \u201ctrue,\u201d revocation or denial is permitted. CMS \ufb01nalizes an addition that reiterates and emphasizes the policy that suppliers and providers are legally responsible for the accuracy and completeness of all information provided with their applications regardless of who completed the application.<\/p>\n<p>CMS is permitted to revoke or deny a provider\u2019s enrollment if their ability to prescribe drugs has been suspended or revoked by the licensing or administrative body for any state where they practice. CMS is \ufb01nalizing the proposal to amend \u201cprescribe drugs\u201d to read \u201cprescribe one or more drugs\u201d to clarify that in this context, a prohibition involving even one drug is adequate grounds for revocation or denial if CMS deems it necessary to protect bene\ufb01ciaries and the Trust Funds.<\/p>\n<p>Under \u00a7 424.535(a)(14), CMS may revoke a provider\u2019s enrollment if the individual has apattern of abusive prescribing of Part B or D drugs. Drugs associated with services covered under Part A do not currently fall within the purview of \u00a7 424.535(a)(14) and accordingly CMS is \ufb01nalizing the proposal to amend this provision to state \u201cMedicare-covered drugs\u201d to encompass Medicare Parts A, B, and D.<\/p>\n<p>Currently, revocation is permitted in the case of a provider abusing their billing privileges and \u00a7 424.535(a)(8) includes potential situations in which this can apply. CMS is \ufb01nalizing the proposal to add the scenario in which the bene\ufb01ciary attests that the items or services identi\ufb01ed on the claim in question were not rendered or furnished as a potential situation.<\/p>\n<p>CMS additionally \ufb01nalizes proposals to:<\/p>\n<ul>\n<li>Expand the bases for which the agency can apply a retroactive revocation effective date,<\/li>\n<li>Impose new deactivation authority in terms of billing for certain services,<\/li>\n<li>Revise stay of enrollment authority,<\/li>\n<li>Have the authority to require the submission of certain other documentation needed for verification of information included on the enrollment application,<\/li>\n<li>Reassign effective dates,<\/li>\n<li>Amend DMEPOS Liability Insurance requirements, and<\/li>\n<li>Clarify deactivation<\/li>\n<\/ul>\n<p><strong>Medicaid Provider Enrollment Provisions<\/strong><\/p>\n<p>CMS \ufb01nalizes a language clari\ufb01cation to Medicaid and CHIP termination requirements. \u00a7455.416(c) states that the provider\u2019s termination must be from Medicare and Medicaid or CHIP program of any state. Thus, CMS is \ufb01nalizing to change the aforementioned \u201cand\u201d reference to \u201cor\u201d consistent with statutory language.<\/p>\n<h3>CMS FINALIZES CHANGES TO DMEPOS SUPPLIER ACCREDITATION PROCESS <span style=\"color: #339966;\"><strong><em>FINALIZED<\/em><\/strong> <strong><em>WITH<\/em> <\/strong><strong><em>MODIFICATION<\/em><\/strong> <strong><em>\u2013<\/em><\/strong> <strong><em>page<\/em><\/strong> <strong><em>414<\/em><\/strong><\/span><\/h3>\n<p>CMS \ufb01nalizes various regulatory changes to the current DMEPOS accreditation process to address fraud, waste, and abuse problems, <strong>including requiring DMEPOS suppliers to be resurveyed and reaccredited annually instead of every three years<\/strong>. CMS also \ufb01nalizes stricter requirements for becoming and remaining a DMEPOS accrediting organization (AO), with a few modi\ufb01cations to timeframes and to provide clari\ufb01cation, and to not \ufb01nalize a few redesignations of language, including:<\/p>\n<ul>\n<li>Restructuring language that explains the process by which an entity may apply or reapply to become an AO for ease of comprehension<\/li>\n<li>Requirements that mandate the AO to explain, in detail, its policies and procedures for avoiding conflicts of interest involving individuals who conduct surveys or participate in accreditation<\/li>\n<li>Requiring the AO describe its process for identifying and correcting deficiencies within its accreditation<\/li>\n<li>Requiring the AO to describe its data management, analysis, and reporting system for its surveys and accreditation<\/li>\n<li>Requiring the AO to explain their procedures for responding to and investigating complaints against its<\/li>\n<li>Requiring the AO to furnish information about its ability to conduct timely reviews of supplier accreditation<\/li>\n<li>Requiring the AO to describe its decision-making<\/li>\n<li>Modifications to exercise greater oversight and gain a clearer understanding of AOs\u2019 corrective action plan (CAP).<\/li>\n<li>Requiring greater explanation of how an AO defines the term \u201cdeficiency\u201d and whether the AO has different levels of supplier<\/li>\n<li>Outlining of AO application for reapproval of DMEPOS accreditation<\/li>\n<\/ul>\n<h3>CMS FINALIZES EXEMPTION PATHWAY FOR COMPLIANT SUPPLIERS FROM DMEPOS PRIOR AUTHORIZATION <em><span style=\"color: #339966;\">FINALIZED AS PROPOSED \u2013 page 420<\/span><\/em><\/h3>\n<p>To reduce administrative burden and improve e\ufb03ciency, CMS \ufb01nalizes a new exemption process for certain DMEPOS suppliers who demonstrate high compliance with Medicare rules. Suppliers with a prior authorization a\ufb03rmation rate of at least 90% would be exempt from prior authorization requirements, e\ufb00ective until CMS withdraws the exemption. Exemptions will be rescinded if the supplier\u2019s non-compliant claim rate exceeds 10%. CMS would provide a 60-day notice before granting or withdrawing an exemption and seeks public comment on theproposed changes.<\/p>\n<p><em>********<\/em><\/p>\n<p style=\"font-weight: 400;\"><em>This Applied Policy\u00ae Summary was prepared <\/em><em>by Simay Okyay McNutt <\/em><em>with support from the Applied Policy team of health policy experts. If you have any questions or need more information, please contact <\/em><em>her<\/em> <em>at<\/em> <a href=\"mailto:sokyay@appliedpolicy.com\"><em>sokyay@appliedpolicy.com<\/em><\/a> <em>,<\/em> <em>or<\/em> <em>at<\/em> <em>(202)<\/em> <em>558-5272.<\/em><\/p>\n<p>Download a copy of this summary <a href=\"https:\/\/www.appliedpolicy.com\/staging\/7403\/wp-content\/uploads\/DMEPOS-CBP-final-rule-first-night-summary-11.28.2025.pdf\">here.<\/a><\/p>\n<p><a href=\"applewebdata:\/\/DAD551DB-163F-4026-A9D0-00152A79C587#_ftnref1\" name=\"_ftn1\">[1]<\/a> See Table 33 on page 507-508 of the unpublished proposed rule.<\/p>\n<p><a href=\"applewebdata:\/\/DAD551DB-163F-4026-A9D0-00152A79C587#_ftnref2\" name=\"_ftn2\">[2]<\/a> De\ufb01ned as \u201ca CBA and product category combination\u201d<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>On November 28, 2025, the Centers for Medicare &amp; Medicaid Services (CMS) released Calendar Year (CY) 2026 Home Health Prospective Payment System and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) Final Rule. CMS released a fact sheet accompanying the \ufb01nal rule. This summary is speci\ufb01cally on provisions related to DMEPOS [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":7089,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","ap4_related_services":"","footnotes":""},"categories":[630,431],"tags":[],"class_list":["post-10318","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hme-dme","category-medicare-reimbursement"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>CMS Finalizes Rule on Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Without Major Changes - Applied Policy<\/title>\n<meta name=\"description\" content=\"CMS released Calendar Year (CY) 2026 Home Health Prospective Payment System and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) Final Rule on November 28.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.appliedpolicy.com\/cms-finalizes-rule-on-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos-competitive-bidding-program-without-major-changes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS Finalizes Rule on Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Without Major Changes - 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