What are CMS’s plans for prior authorization demonstration

 - 
Tuesday, January 23, 2018

WASHINGTON – A Medicare demonstration project requiring prior authorizations for standard power wheelchairs in 19 states expires this August.

“We’ve had some initial conversations with Medicare with regard to what they plan to do,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products. “We remain hopeful that it will become a permanent part of the program.”

CMS’s last action on the demo: In July 2015, the agency extended the demo through August 2018.

Stakeholders have told CMS they’d like to see the agency expand prior authorizations to the remaining states and also require them for complex rehab wheelchairs.

“The demo has been very successful, from a provider perspective and CMS perspective,” Johnson said

During the demo for standard power wheelchairs, CMS also started requiring prior authorizations for two complex rehab codes, K0856 and K0861, in 2017.

“We’d like to see it become standard procedure across the board,” Johnson said.

The demo kicked off in seven states in September 2012 and was expanded to 12 states in 2014, bringing the total to 19.