PMD demo extended, but not expanded

By Tracy Orzel, Associate Editor
Friday, July 17, 2015

WASHINGTON – Industry stakeholders say CMS’s decision to extend the PMD demo through August 2018 is a step in the right direction, but more needs to be done. 

“We’re looking to expand the demo to all 50 states and to include Group 3 complex rehab items, as well as options and accessories provided on all power mobility devices,” said Seth Johnson, vice president of government affairs for Pride Mobility Products.

CMS on Wednesday announced its decision to extend the PMD demo, which was set to expire Aug. 31, in the Federal Register. 

The demo, which requires prior authorizations for certain PMDs, kicked off in seven states in September 2012 and was expanded to an additional 12 states in 2014.

Stakeholders have since reached out to the agency to discuss its willingness to expand the demo nationwide and include more products.

“Once they respond, we’ll make a determination on what the best strategy is to continue to improve this program,” said Johnson. 

Stakeholders chalk up CMS’s decision not to expand the demo’s reach to a lack of time and staff. 

“A lot of resources need to go into rolling out a nationwide program to accommodate all those prior authorization requests that would be coming in,” said Martin Szmal, founder of The Mobility Consultants. 

Prior to CMS’s decision, the House of Representatives on July 10 passed a 21st Century Cures Act that included a provision extending the demo for three years. 

One thing included in the bill that was not included in CMS’s announcement: a provision that would limit audits of claims that have already had an advance determination of medical necessity.

“That’s important because it would give appropriate protection to providers,” said Don Clayback, executive director of NCART. “If you’re submitting information up front, and they’re reviewing and approving it, you shouldn’t have to be second guessed two years down the road by someone who isn’t familiar with the claim.”