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2026 DME Proposed Rule: What Providers Need to Know
Manage episode 498473140 series 3401731
CMS has proposed significant DME regulation changes in the 2026 Home Health Payment Update Rule that focus on combating fraud, improving supplier compliance, and enhancing efficiency through increased oversight and expanded requirements. The proposed changes would dramatically impact DME operations through annual accreditation surveys, expanded competitive bidding, and enhanced data reporting requirements.
• Annual accreditation surveys instead of the current three-year cycle would increase costs and operational burden
• Expanded competitive bidding to include continuous glucose monitors, insulin pumps, and certain medical supplies
• Prior authorization exemption process for providers with 90% or higher claim approval rates
• Enhanced oversight requirements and increased data submission for both providers and accrediting organizations
• Significant financial impact through decreased reimbursement rates paired with increased costs
• Comments are due by August 29, 11:59 PM
We strongly encourage DME providers to review the proposed rule and submit comments with data, beneficiary stories, and constructive suggestions. Visit the CHAP website for a summary of DME provisions or contact your state and national associations for guidance in developing your comment letter.
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Chapters
1. Introduction to DME Rule Changes (00:00:00)
2. Shannon Dorsey's DME Expertise (00:03:51)
3. Proposed Annual Accreditation Surveys (00:06:31)
4. Exemption Process for Prior Authorization (00:09:59)
5. Competitive Bidding Program Changes (00:10:54)
6. Enhanced Oversight Requirements for AOs (00:15:32)
7. Provider Comment Period and Next Steps (00:21:30)
46 episodes
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