The Centers for Medicare and Medicaid Services' (CMS) 3-year Medicare Prior Authorization for Power Mobility Device (PMD) demonstration begins September 1. The demonstration is designed to develop and demonstrate improved methods for the investigation and prosecution of fraud in the provision of care or services. CMS believes this demonstration will lead to reductions in improper payments for power mobility devices.
CMS will implement a prior authorization process for scooters and power wheelchairs for people with fee-for-service Medicare who reside in 7 states with high populations of fraud- and error-prone providers (California, Illinois Michigan, New York, North Carolina, Florida, and Texas). Additionally, this demonstration will help ensure that a beneficiary's medical condition warrants his or her medical equipment under existing coverage guidelines and assist in preserving a Medicare beneficiary's ability to receive quality products from accredited suppliers.
Based on comments from APTA and other stakeholders, CMS removed the 100% prepayment review phase (formerly Phase 1) from the demonstration earlier this year. Also based on stakeholder feedback, CMS will allow suppliers to perform the administrative function of submitting the prior authorization request on behalf of the physician/treating practitioner.
Additional information is available on CMS' website.