Medicare’s controversial power mobility device (PMD) demonstration project has started in seven states.
The three-year project requires prior authorization for most power wheelchairs and all scooters purchased by Medicare for beneficiaries in California, Florida, Illinois, Michigan, New York, North Carolina and Texas.
In the days leading up to the Sept. 1 start date, the American Association for Homecare (AAHomecare) sought a 30-day postponement of the project’s implementation amidst concerns that the project was being too hastily rolled out.
In a press release about its call for a delay, AAHomecare pointed out that five days before implementation, stakeholders still “hadn’t received an operational guide with comprehensive instructions for the program.”
The organization had therefore wanted a delay of 30 days from the time the operational guide’s final version was published on the Center for Medicare & Medicaid Services (CMS) Web site “to ensure that providers, physicians and beneficiaries have been educated on all aspects of the program.”
In the last few days before the start of the demonstration project, AAHomecare sent out an update saying CMS “has accepted AAHomecare’s recommendations that allow physicians to use a clinical medical necessity template when documenting the face-to-face exam with a Medicare beneficiary. AAHomecare had strenuously argued that without a guide to help physicians document the coverage criteria to support medical necessity, Medicare beneficiaries would not receive prescribed PMDs on a timely basis.”
In addition to the outcry from industry stakeholders, consumer advocacy groups including the American Association of People with Disabilities and United Spinal Association have also objected to the demonstration project, citing worry over timely access to PMD for consumers.
When the project was announced in mid November, it included a first-phase pre-payment review requirement in all seven participating states. That phase was eliminated before the project was implemented.
Other changes that occurred after the initial project announcement included the fact that CMS “now allows suppliers to perform the administrative function of submitting the prior authorization request on behalf of the physician/practitioner,” according to the project’s Web site.
CMS has also said it will review resubmitted claims – i.e., PMD claims denied upon first review, but resubmitted by the supplier – in 20 business days instead of 30.
