CMS: PMD spending continues downward slide

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Thursday, May 29, 2014

WASHINGTON – Spending on power mobility devices (PMDs) continues to fall nationwide since the September 2012 launch of a demo requiring prior authorizations in seven states, CMS says.

Monthly expenditures for PMD codes dropped from $12 million in September 2012 to $3 million in December 2013 in demo states, and from $20 million to $6 million in non-demo states across the same time period, according to an update. 

“While we recognize that multiple factors contributed to the decrease in PMD expenditures, there was also a significant decrease in the number of beneficiaries receiving PMDs in the demonstration states after the start of the demonstration,” CMS wrote. “We believe this decrease is because prior authorization is ensuring that only beneficiaries who meet Medicare requirements receive a PMD.”

CMS had previously reported that expenditures for PMD codes dropped from $12 million in September 2012 to $4 million in September 2013 in demo states and to $9 million across the same time period in non-demo states.

From Sept. 1, 2012, to Dec. 31, 2013, the number of beneficiaries receiving PMDs fell by 75% in demo states and by 66% in non-demo states, CMS says. Of the 36,201 prior authorization requests submitted by Dec. 31, 2013, about half were denied. 

Other findings in the update: The DME MACs completed reviews of submissions within 10 business days and of resubmissions within 20 business days, and just 2,537 of 44,030 submissions were sent electronically.

Assuming monthly expenditures on PMDs stayed at $32 million per month, CMS estimates spending has decreased by $202 million since the demo began.

CMS plans to expand the PMD demo to 12 new states.

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