Medicare PMD Demonstration Expansion Is Underway

Medicare's power mobility device (PMD) demonstration project has been expanded to an additional 12 states, bringing the total number of participating states to 19.

The expansion of the demonstration project, which requires prior authorization and accompanying medical justification for scooters and most power wheelchairs, began on Oct. 1.

States joining the in-progress demonstration are Arizona, Georgia, Indiana, Kentucky, Louisiana, Maryland, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee and Washington.

California, Florida, Illinois, Michigan, New York, North Carolina and Texas were the first states to participate in the demonstration. The demonstration project will end for all 19 states on Aug. 31, 2015.

In the July 29, 2014, edition of the Federal Register, the Centers for Medicare & Medicaid Services (CMS) said the states were chosen "based upon their history of having high levels of improper payments and incidents of fraud related to PMDs. The objective of the demonstration is to develop improved methods for the investigation and prosecution of fraud in order to protect the Medicare Trust Fund from fraudulent actions and any resulting improper payments."

PMDs involved in the demonstration project are 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).

Upon receiving the documentation, CMS said in the Federal Register, the organization "will make every effort to conduct a complex medical review and postmark the notification of their decision with the prior authorization number within 10 business days."

CMS's decision is sent to the physician who wrote the prescription for the PMD, the PMD provider, and the Medicare beneficiary.

Expedited reviews of documentation may be requested if that 10 business-day waiting period "could seriously jeopardize the beneficiary's life or health," CMS added. CMS tries to provide decisions on expedited reviews within 48 hours of receiving them.

To view the article in the Federal Register, click HERE.

About the Author

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

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