CMS Announces Major Changes to Medicare PMD Demonstration Project

CMS has just announced major changes to the PMD Demonstration Project that was originally scheduled to start on January 1st but was delayed based on stakeholders’ comments.   This Demonstration Project applies to PMD providers in the states of California, Texas, Florida, Michigan, Illinois, North Carolina, and New York.  Attached is the one page CMS announcement and below are the announced changes:

 

1.)    CMS has set a new target date of June 1, 2012 or later to begin the demonstration.

2.)    CMS has submitted the necessary PRA (Paper Reduction Act) package for public comment. This will allow providers and supplier at least 60 days to comment on the collection of information burden of the demonstration.

3.)    CMS has eliminated the prepayment review phase (formerly Phase 1) and will go straight to Prior Authorization.

4.)    The physician/ treating practitioner or supplier on behalf of the physician/ treating practitioner may perform the administrative function of submitting the Prior Authorization request.

5.)    All demonstration states will start prior authorization at approximately the same time.

 

CMS also announced they will be holding several Open Door Forums (dates not published yet) and will engage in intensive physician and supplier educational outreach.

 

These are significant changes and are a direct result of industry advocacy.  We appreciate CMS taking the comments received seriously and making needed changes.  We continue to have active dialogue with the CMS implementation team and others on our additional concerns and recommendations.  We will continue to update you as things develop.

Prior Authorization of Power Mobility Devices (PMD) Demonstration

CMS Press Release