Blackburn’s bill seeks to expand prior authorizations

Tuesday, May 26, 2015

WASHINGTON – Rep. Marsha Blackburn, R-Tenn., introduced a bill last week that would require prior authorizations for high-dollar DME.

The bill, H.R. 2437, would also exempt DME that has gone through this prior authorization process from pre- and post-payment audits, according to The VGM Group.

“These pre-approved items could then only be subject to audits for fraud and abuse purposes,” the group stated in a bulletin to members. “The intention of this is to reduce the number of intrusive audits on suppliers.”

The bill has been referred to the House Energy and Commerce and Ways and Means committees for consideration, according to the Library of Congress website. Currently, there is no text for the bill available.

CMS is already running a demo project requiring prior authorizations for power mobility devices. Last year, it also outlined plans to implement prior authorizations for some 134 products that it believes are frequently overutilized, such as CPAP devices.

Blackburn has long been a champion of industry efforts to reform Medicare’s audit program. Last year, she was one of a group of lawmakers to pressure CMS not to retrospectively audit providers for compliance with the face-to-face requirement. The agency has implemented, but still has not started enforcing, the requirement. 

Additionally, two years ago, she was part of a delegation that sent a letter to CMS voicing concerns that it had awarded bids to unlicensed providers as part of Round 2 of competitive bidding.

In 2012, the Association of Tennessee Home Oxygen and Medical Equipment Services chose Blackburn as its Champion for Homecare.