Centers for Medicare & Medicaid Services
Special Open Door Forum:
Medicare Prior Authorization Initiatives
Tuesday, June 17, 2014
2:00 p.m. - 3:00 p.m. EST
Conference Call only
CMS will host a Special Open Door Forum (ODF) to allow Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) suppliers, physicians, treating practitioners, ambulance suppliers and other interested parties to learn about new prior authorization initiatives recently announced by CMS. The initiatives that will be discussed include the Medicare Expanded Prior Authorization Demonstration for Power Mobility Devices (PMDs) Demonstration, the Hyperbaric Oxygen and Repetitive Scheduled Non-Emergent Ambulance Transport prior authorization models and a new proposed rule for prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies.
The purpose of this Special Open Door Forum (ODF) is to provide an opportunity for suppliers and providers to receive information on all of the prior authorization initiatives.
On September 1, 2012 the CMS implemented a prior authorization process for PMDs (scooters and power wheelchairs) in seven states with high populations of fraud- and error-prone providers (CA, IL, MI, NY, NC, FL and TX). Initial data indicates that the Prior Authorization Demonstration was successful in reducing spending and improper payments for PMDs. The CMS believes the recent decrease in overall spending is due in part to national Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers adjusting their billing practices and reflects suppliers complying with CMS policies based on their experiences with prior authorization in the demonstration states. Prior authorization is driving initial successes, ensuring that only beneficiaries who meet Medicare requirements receive a PMD. Suppliers have also increased compliance with CMS policies based on their experiences with prior authorization in the demonstration states.
Based on the demonstration’s initial success in reducing spending and improper payments, and the support received by various stakeholders, CMS seeks to expand the current demonstration to 12 additional states, for a total of 19 states, with all demonstration requirements remaining the same. Those states include: Pennsylvania, Ohio, Louisiana, Missouri, Maryland, New Jersey, Indiana, Kentucky, Georgia, Tennessee, Washington, and Arizona. To read more about the Demonstration visit: http://go.cms.gov//PADemo.
CMS also proposes to establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies items that are frequently subject to unnecessary utilization. Through a proposed rule, CMS will solicit public comments on this prior authorization process, as well as criteria for establishing a list of durable medical items that are frequently subject to unnecessary utilization that may be subject to the new prior authorization process. The proposed rule may be found at http://www.gpo.gov/fdsys/pkg/
FR-2014-05-28/pdf/2014-12245. pdf. The deadline to submit comments is July 28, 2014.
Finally, CMS will launch two models that will test prior authorization for certain non-emergent services under Medicare. These services include hyperbaric oxygen therapy and repetitive scheduled non-emergent ambulance transport.
Participants will not be able to ask questions on the call but we encourage participants to submit questions prior to the call to the Special ODF to: MedicareMedicalReview@cms.hhs.
We look forward to your participation.
Special Open Door Participation Instructions:
Participant Dial-In Number: (800) 837-1935
Conference ID #: 41801913
Note: TTY Communications Relay Services are available for the Hearing Impaired. For
TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
A transcript and audio recording of this Special ODF will be posted to the Special Open
Door Forum website at
OpenDoorForums/05_ODF_ SpecialODF.asp and will be accessible for downloading.
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Thank you for your interest in CMS Open Door Forums.