CMS Delays PMD Demonstration Project
- By Laurie Watanabe
- Dec 29, 2011
The Centers for Medicare & Medicaid Services (CMS) has delayed implementation of a controversial power mobility device demonstration project that would impact claims for most types of power wheelchairs and all scooters in seven highly populous states.
Announcement of the delay came Dec. 29, just days before the original Jan. 1, 2012, implementation date.
A Dec. 30 bulletin from NHIC Corp., the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC), an entity responsible for approving Medicare claims, said CMS delayed implementation due to "many comments/suggestions regarding these demonstrations" and said the agency "is carefully considering these comments."
A new implementation date was not announced. The NHIC bulletin said, "CMS will provide at least 30 days' notice before the demonstrations begin."
The other three DME MACs sent similar bulletins or posted the announcement of the delay on their Web sites. Noridian Administrative Services, the Jurisdiction D DME MAC, also announced that listening sessions scheduled for next week and related to the demonstration project had been cancelled due to the delay.
All four DME MACs serve at least one of the seven affected states.
The Demonstrations page on CMS's Web site said, "This demonstration is delayed until further notice."
The demonstration project, originally announced Nov. 15, is composed of two parts, the first of which would require prepayment reviews for all claims involving the following equipment in the affected states:
- Power-operated vehicles (aka, scooters): HCPCS codes K0800-K0805 and K0809-K0812
- Standard power chairs: HCPCS codes K0813-K0829
- Group 2 complex rehab power chairs: HCPCS codes K0835-K0843
- Group 3 complex rehab power chairs without power options: HCPCS codes K0848-K0855
- Pediatric and Group 4 power chairs: HCPCS codes K0887-K0891
- Miscellaneous power wheelchairs with HCPCS code K0898
The seven states selected for the demonstration project are California, Florida, Illinois, Michigan, New York, North Carolina and Texas. The second portion of the demonstration project will require prior authorization in those seven states for Medicare claims involving those PMDs.
In a Dec. 29 memo, the American Association for Homecare (AAHomecare) said the delay was the "result of intensive collaboration between the Centers for Medicare & Medicaid Services and AAHomecare," and added that the association had also worked with other clinical, consumer and industry stakeholders in seeking a delay.
In response to the delay, Walt Gorski, AAHomecare VP of government affairs, said, "We are pleased that CMS has taken a deep breath to better understand the power mobility sector and the impact that any widespread prepayment review would have on Medicare beneficiaries and homecare providers."
The sudden announcement in mid November of the demonstration project raised multiple serious concerns among mobility and complex rehab technology providers still adjusting to other recent Medicare funding and policy changes, including the elimination of the first-month purchase option for many power chairs. The demonstration project was due to take place in states with large Medicare populations, which raised questions about how prepayment review would impact timely delivery of equipment to the people who need it.
In addition, there were questions as to how quickly the DME MACs could hire and train staffers to accurately conduct detailed reviews of PMD claims for beneficiaries with highly complex medical conditions and needs.
Laurie Watanabe is the editor of Mobility Management. She can be reached at email@example.com.