CMS Announces Demonstration Project for Power Mobility Devices will move Forward in June 2012
UPDATE—February 23, 2012
Additional CMS modifications to the Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration include the following:
- CMS has completed a separate Paperwork Reduction Act (PRA) notification for this demonstration
- CMS has removed the 100% Pre-Payment review phase (formerly Phase 1)
- CMS will allow suppliers to perform the administrative function of submitting the prior authorization request on behalf of the physician/treating practitioner
- This demonstration will begin only after an OMB PRA control number is obtained; CMS anticipates the start of this demonstration will be on or after Fri June 1, 2012
CMS is hosting a Special Open Door Forum on the PMDs Demonstration on Thursday, February 23, 2012 from 3-4:30pm ET. To participate, dial (877) 251-0301 and use conference ID 54397724 (TYY dial 7-1-1). Submit questions in advance to PAdemo@cms.hhs.gov.
For additional information on this call, including participation instructions, please visit http://www.CMS.gov/OpenDoorForums/Downloads/
022312SODFEndStageDesease.pdf. A transcript and audio recording of this Special Open Door Forum will be posted to the Special Open Door Forum website: http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading on or around March 22, 2012 and will be available for 30 days. For automatic emails of Open Door Forum schedule updates visit http://www.cms.gov/opendoorforums.
UPDATE—February 3, 2012
CMS announced on February 2, 2012, that the prior authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration will move forward on or after June 1, 2012. AOTA policy staff will be analyzing details of the demonstration project. Members with concerns about the demo are urged to contact staff at: RRPD@aota.org.
The CMS announcement dated 2/3/12 states:
- CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration which were delayed from their initial January 1, 2012 start date are expected to move forward on or after June 1, 2012. For additional information on these demonstrations please visit http://go.cms.gov/cert-demos
- These demonstrations will begin after receipt of a paperwork reduction act (PRA) Office of Management and Budget (OMB) control number. The CMS posted a PRA notification from these demonstrations on February 3, 2012 at http://www.cms.gov/PaperworkReductionActof1995/PRAL/list.asp.
- The CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.cms.gov/PAdemo
UPDATE – January 3, 2012
CMS announced on December 29, 2011 that it had received many comments regarding the demonstration project for power mobility devices. CMS is considering the comments carefully and as a result will delay the implementation of this demonstration project. CMS will provide at least 30 days notice before the demonstration begins.
On November 15, 2011, CMS announced that it will conduct a two-stage demonstration project that will require prepayment review and then prior authorization for power mobility devices covered by Medicare in seven states (CA, IL, MI, NY, NC, FL, and TX). CMS reports that these states have high error rates and incidents of fraud.
According to a press release issued by CMS, Beginning on January 1, 2012, “CMS will conduct a demonstration project to strengthen Medicare by aiming at eliminating fraud, waste, and abuse and this is an important step toward paying appropriately for certain medical equipment that has a high error rate.”
On December 5, 2011, CMS held an open door forum to disseminate information about the project and for providers to ask questions about the Power Mobility Demonstration Project.
AOTA is concerned that the demonstration project could inconvenience Medicare beneficiaries, delay access to needed care, and create burdens on providers including occupational therapists who might be involved in the required evaluations. AOTA’s Reimbursement and Regulatory staff welcome comments on how this demonstration project will impact occupational therapy practitioners and the clients they serve. Please e-mail comments to RRPD@aota.org.
Additional Resources
CMS Demonstration Announcement Page
CMS Press Release regarding the Open Door Forum
CMS Demonstration Page including contact e-mail and Twitter address
Prior Authorization of Power Mobility Devices Demonstration Q&A as of 12/13/11
Prior Authorization of Power Mobility Devices Provider Outreach/Education Slides
Prior Authorization Start Dates
Suggested Cover Sheet [PDF, 78 KB]
Process Flowchart [PDF, 240 KB]
Examples of Medical Record Documentation: Potentially Sufficient and Insufficient to Support Coverage of Power Mobility Devices [PDF, 510 KB]
Summary of Demonstration Modifications updated 2-16-12 [PDF, 115 KB]
Fact Sheet: General Information [PDF, 55.1 KB]
ODF Announcement [PDF, 29.3 KB]
ODF Schedule [PDF, 115 KB]
Open Door Forum Call Slides 2-23-2012
Power Mobility Device Face-to-Face Examination Checklist
Power Mobility Devices: Complying with Documentation
PRA Listing
Medicare's Prepayment Review and Prior Authorization Demonstration Project For Power Mobility Devices
PMD NCD (Section 280.3)
PMD Face to Face Regulation
