CMS Plans to Expand PMD Prior Authorization Demo

The Centers for Medicare & Medicaid Services (CMS) has announced in the Federal Register that it intends to expand the power mobility device (PMD) prior authorization demonstration that's currently in progress in seven states.

Volume 79, Number 65 of the Federal Register, published April 4, included preliminary information about expanding the demonstration project to 12 additional states: Arizona, Georgia, Indiana, Kentucky, Louisiana, Maryland, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee and Washington.

The demo is currently active in California, Florida, Illinois, Michigan, New York, North Carolina and Texas.

In the Federal Register, CMS said, "We believe that this demonstration prevents public harm by protecting the Medicare Trust Fund from improper payments made for PMDs that do not comply with Medicare policy by ensuring that a beneficiary's medical condition warrants the medical equipment ordered."

Providers working with beneficiaries residing in the seven states currently under the demonstration project must seek prior authorization for most PMDs, including Group 1 power-operated vehicles (aka, scooters); all Group 1 and Group 2 standard power wheelchairs (HCPCS codes K0813-K0829); Group 2 power wheelchairs coded K0835-K0843; Group 3 power wheelchairs without power options (K0848-K0855); pediatric power wheelchairs (K0890-K0891); and miscellaneous power wheelchairs (K0898).

The current demonstration project, slated for a three-year term, applies to PMD claims dated Sept. 1, 2012, or later.

CMS selected the seven states based on their "high populations of fraud- and error-prone providers."

At the time the demonstration started, industry experts also pointed out that beneficiaries those seven states accounted for more than 40 percent of PMDs purchased by Medicare.

When CMS originally announced the demonstration, it included a first-phase prepayment review, which was eliminated prior to the project's start. The demonstration went ahead with just the prior authorization requirement - originally slated to be the second phase of the project - in place.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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