HB 2005 directs the Secretary of Health and Human Services to adjust Medicare payments for durable medical equipment that were included in Round 2021 of the DMEPOS competitive bidding program. The bill applies the transition rule to all applicable items and services furnished in non-rural, non-contiguous areas through December 31, 2025.
It also prohibits implementing the companion nationwide rule before January 1, 2026, and allows the Secretary to implement these changes by program instruction or other administrative means. In short, this measure creates a staged approach to former DMEPOS bid-based payments, buying time for market and operational adjustments while preserving policy options in the near term.
At a Glance
What It Does
The bill requires applying the 414.210(g)(9)(v) transition rule to DMEPOS items in non-rural/non-contiguous areas through 12/31/2025. It bars the nationwide 414.210(g)(9)(vi) rule from taking effect before 1/1/2026. It authorizes implementation of these provisions via program instruction or other administrative means.
Who It Affects
DMEPOS suppliers and distributors in urban/non-contiguous markets, Medicare Administrative Contractors and CMS program staff, and beneficiaries who rely on DME in these areas. The rules principally affect items from Round 2021 of the DMEPOS bidding program.
Why It Matters
The staggered approach reduces abrupt price changes in ongoing markets through 2025 while preserving a clear path to nationwide alignment in 2026. It also centralizes implementation authority, potentially shortening the policy rollout but concentrating control in CMS discretion.
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What This Bill Actually Does
This bill targets durable medical equipment (DME) items that were part of the 2021 DMEPOS competitive bidding round. It directs the Secretary to apply a transition rule to non-rural, non-contiguous areas, ensuring that payment adjustments under the successor framework proceed through the end of 2025.
Separately, it blocks the immediate nationwide application of the corresponding rule for all areas until 2026, maintaining the status quo in other regions during that period. The Act also allows CMS to implement these changes through program instruction or other administrative mechanisms rather than requiring new legislation each time.
The overall effect is a carefully staged reform of DMEPOS payments that aims to avoid abrupt disruptions for providers and beneficiaries while giving CMS flexibility in implementation.
The Five Things You Need to Know
Section 2(a) applies the 414.210(g)(9)(v) transition to non-rural/non-contiguous areas through 12/31/2025.
Section 2(b) delays nationwide implementation of 414.210(g)(9)(vi) until 1/1/2026.
Section 2(c) permits implementation through program instruction or other administrative means.
The policy focuses on items from Round 2021 of the DMEPOS competitive bidding program.
The bill is titled the DMEPOS Relief Act of 2025.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short Title
Establishes the act’s short title as the DMEPOS Relief Act of 2025, signaling its narrow aim to adjust Medicare payment rules for DMEPOS items originating from the 2021 bidding round.
Non-rural/non-contiguous transition for DMEPOS payments
Directs the Secretary to apply the transition rule described in 414.210(g)(9)(v) to all applicable DMEPOS items in areas other than rural or noncontiguous through December 31, 2025. This creates a phased adjustment period for urban and similar markets while leaving rural and contiguous areas out of this particular transition.
Nationwide implementation delayed
Prohibits the implementation of the 414.210(g)(9)(vi) transition for all areas until January 1, 2026, thereby postponing nationwide changes beyond 2025 and maintaining current payment dynamics in the interim.
Implementation authority
Affirms that the Secretary may implement the provisions of Section 2 via program instruction or other administrative means, allowing operational flexibility to carry out the transition without new statutory changes.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- DMEPOS suppliers operating in urban/non-contiguous markets benefit from a predictable transitional framework that avoids abrupt rate changes through 2025.
- Medicare beneficiaries relying on DME in non-rural areas benefit from continued, albeit transitional, access with a stable payment environment through 2025.
- CMS and Medicare Administrative Contractors gain a clearer, administratively feasible path to implement the transitional rules via program instruction.
- Manufacturers and distributors linked to Round 2021 DMEPOS items may experience more stable near-term demand under the transition.
Who Bears the Cost
- CMS and MACs incur administrative costs to implement and monitor the transitional rates through 2025 and prepare for 2026 nationwide changes.
- DMEPOS providers in affected markets bear transitional pricing adjustments and potential revenue uncertainty during the 2025 window.
- Payers and health systems that align with Medicare payment changes may face transitional pricing alignment challenges and the need to manage payer communications and forecasting.
- Beneficiaries in affected markets could face short-term price volatility or coverage uncertainties during the transition period.
Key Issues
The Core Tension
The central dilemma is balancing a cautious rollout with the need for uniform nationwide reform. Delaying 414.210(g)(9)(vi) to 2026 preserves current pricing in some markets, but risks creating geographic inconsistency and a two-tier system in the near term.
The bill trades a rapid nationwide update for a staged approach that prioritizes continuity in pricing and DME access through 2025. While the transition aims to reduce disruption for urban and noncontiguous areas and gives CMS flexibility to implement via program instruction, it raises questions about how and when permanent, nationwide reforms will take effect and how beneficiaries in different geographies will be treated consistently.
The reliance on administrative implementation rather than new statute could also shift future policy risk back onto CMS operational decisions rather than statutory safeguards.
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