CMS targets 12 new states for PMD demo

Friday, April 4, 2014

WASHINGTON – The PMD demo is about to get bigger.

In an April 4 emergency federal register notice, CMS details plans to expand its prior authorization program to 12 new states: Pennsylvania, Ohio, Louisiana, Missouri, Maryland, New Jersey, Indiana, Kentucky, Georgia, Tennessee, Washington and Arizona. 

That will bring the total number of demo states to 19.

“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 and by ensuring that a beneficiary’s medical condition warrants the medical equipment ordered,” the agency stated.

The demo, which requires providers or physicians to submit prior authorization requests to DME MACs for evaluation before an item is delivered or service rendered, has been in place in seven states—California, Texas, Illinois, Michigan, New York, North Carolina and Florida—since September 2012.

As a result of the demo, spending on power mobility devices fell from $11 million in September 2012 to $5 million in June 2013.

In the notice, CMS asks the Office of Management and Budget to review and approve its request by April 18. 

HME News recently reported that, at the behest of the Senate Finance Committee, the industry has drafted language that would expand the demo to all 50 states and would expand it to include all power mobility devices, including Group 3 wheelchairs.