Nursing homes residents who use continuous glucose monitors (CGMs) to track their daily blood sugar levels would see their Medicare coverage and payments for the devices expanded under a new proposed rule by the federal government.
The Centers for Medicare & Medicaid Services on Tuesday announced a proposal for several new changes to Medicare Durable Medical Equipment (DME), Prosthetics, Orthotic Devices and Supplies (DMEPOS) coverage and payment policies. The agency currently covers only therapeutic CGMs or those federally approved for making diabetes treatment decisions.
CMS would classify all CGMs, not just limited to therapeutic CGMs, as DME and establish payment amounts for these items and related supplies and accessories if the rule is finalized, the agency explained. It also added that devices that aren’t approved for making treatment decisions can be used to alert a patient about potentially dangerous glucose levels and to seek further testing.
“With one in every three Medicare beneficiaries having diabetes, this proposal would give Medicare beneficiaries and their physicians a wider range of technology and devices to choose from in managing diabetes,” CMS explained. “This proposal will improve access to these medical technologies and empower patients to make the best healthcare decisions for themselves.”
The proposed rule also aims to expand the interpretation for when external infusion pumps are appropriate to use in the home and cover the equipment as DME under Medicare Part B. It would also reduce administrative burdens, like pricing determinations and coding processes, for DMEPOS.
A fact sheet on the proposed rule can be found here.