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GAO-20-42R 1 (2019-10-10)

handle is hein.gao/gaobaeaap0001 and id is 1 raw text is: G U.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 October 10, 2019 The Honorable Chuck Grassley Chairman The Honorable Ron Wyden Ranking Member Committee on Finance United States Senate The Honorable Frank Pallone, Jr. Chairman The Honorable Greg Walden Ranking Member Committee on Energy and Commerce House of Representatives The Honorable Richard Neal Chairman The Honorable Kevin Brady Ranking Member Committee on Ways and Means House of Representatives Medicare: Spending on Certain Disposable Wound Care Devices in Home Health Medicare fee-for-service's durable medical equipment (DME) benefit covers medical devices that are appropriate for use in the home and have an expected lifetime of at least 3 years, among other criteria. While new medical technology that is disposable may potentially substitute for DME in certain circumstances, disposable devices generally have not been covered by Medicare as DME because they are not considered durable.1 The Consolidated Appropriations Act, 2016, provided for a separate payment for disposable negative pressure wound therapy (NPWT) devices under Medicare's home health benefit as of January 1, 2017.2 Under the Medicare home health benefit, home health agencies provide services to Medicare beneficiaries that are homebound and need skilled nursing or therapy services, with all services 1The Centers for Medicare & Medicaid Services has defined DME as equipment that (1) can withstand repeated use; (2) has an expected lifetime of at least 3 years; (3) is used primarily to serve a medical purpose; (4) is not generally useful in the absence of an illness or injury; and (5) is appropriate for use in the home. See 42 C.F.R. § 414.202 (2018). The 3-year minimum lifetime requirement is effective for items classified as DME after January 1, 2012. We previously reported on issues for consideration related to the potential Medicare coverage of disposable medical devices. See GAO, Medicare: CMS Should Evaluate Providing Coverage for Disposable Medical Devices That Could Substitute for Durable Medical Equipment, GAO-1 7-600 (Washington, D.C.; Jul 17, 2017). 2pub. L. No. 114-113 § 504(a), (b), 129 Stat. 2242, 3021 (2015)(codified at 42 U.S.C. §§ 13951(a)(1), 1395m(s) and 1395x(m)(5). The act covers disposable negative pressure wound therapy devices only for beneficiaries who are receiving home health services. GAO-20-42R Medicare Spending for Disposable Devices Page 1

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