Prior Authorization of Power Mobility Devices (PMDs) Demonstration

Will require Prior Authorization for power mobility devices for all people with Medicare who reside in seven states with high populations of fraud- and error-prone providers (CA, FL, IL, MI, NY, NC and TX). This demonstration will help ensure that a beneficiary’s medical condition warrants their medical equipment under existing coverage guidelines. Moreover, the program will assist in preserving a Medicare beneficiary’s right to receive quality products from accredited suppliers. The demonstration will be implemented in two phases. During the first phase (the first three to nine months), the Medicare Administrative Contractors will conduct prepayment reviews on power mobility device claims. These reviews will be completed within 20 days of receipt of documentation. If the claim is denied the supplier will receive a detailed denial letter. The second phase, for the remainder of this three-year demonstration, will implement prior authorization, a tool utilized by private-sector health care payers to prevent improper payments and deter fraud. The CMS will be conducting two Special Open Door Forum Conference Calls on the Prior Authorization and Prepayment Review of Power Mobility Devices Demonstration