Under the proposed rule, Medicare would cover some external infusion pumps if it's medically necessary, and the program already pays for related home infusion therapy services, according to a CMS fact sheet. It would also enable benefit classification and pricing decisions to happen on the same day the billing codes used for payment of new items take effect, CMS said in a statement.
CMS also wants to expand coverage and payment to include all continuous glucose monitors. Medicare covers therapeutic continuous glucose monitors now. But under the proposed rule, Medicare would cover monitors that aren't approved to make decisions about diabetes treatment "to alert beneficiaries about potentially dangerous glucose levels while they sleep (and) give Medicare beneficiaries and their physicians a wider range of technology and devices to choose from in managing diabetes," CMS said in a statement.
"With the policies outlined in this proposed rule, innovators have a much more predictable path to understanding the kinds of products that Medicare will pay for," CMS Administrator Seema Verma said in a statement.
The agency plans to continue paying suppliers higher amounts for durable medical equipment, prosthetics, orthotic devices and supplies furnished in rural and remote areas to ensure beneficiary access and choice.