After barrage of criticism and concern, CMS delays power mobility prepayment review project

Besieged for weeks by the HME industry, politicians and advocates for the disabled, the Centers for Medicare & Medicaid Services announced Thursday that it was indefinitely delaying a demonstration project that would have required prepayment reviews of power mobility devices in seven states.

The project was supposed to start Jan. 1, and the HME industry responded to the last-minute reprieve with relief.

“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,” Walt Gorski, the American Association for Homecare’s vice president of governmental affairs, said in a prepared release. AAHomecare had worked with its members on the Complex Rehab and Mobility Council and others to stop the project.

CMS surprised and stunned the power mobility sector, doctors and consumers groups on Nov. 15 when it announced the three-year project to require prepayment review for all Medicare power wheelchair claims in seven states – California, Florida, Illinois, Michigan, New York, North Carolina and Texas. AAHomecare said the project would affect nearly half of all Medicare beneficiaries who require power mobility.

Medicare officials said the initiative was necessary to prevent fraud, claims errors and improper payments. The power mobility sector said the initiative would create confusion, chaos and disruptions of services. One of the main problems with the payment review was that it would have come after the wheelchair had been dispensed and used by a Medicare beneficiary.

The power mobility sector has been targeted over the past three years by new Medicare regulations and cost-cutting. Last year, CMS eliminated the first-month purchase option for standard power mobility devices and replaced it with a requirement that providers rent devices to patients over a 13-month period. CMS has also added program integrity requirements, surety bonds requirements and quality standards.

Recently, more than 20 members of Congress signed a letter asking CMS to halt the demonstration project. The Dec. 15 letter cited pressures that have mounted on the power mobility sector and “potential threats to businesses, jobs and seniors’ access to care.”

In addition, AAHomecare and other mobility stakeholders met with the federal Office of Management and Budget to discuss concerns about the project. Later, OMB denied CMS emergency approval required to collect information related to widespread probe reviews. It’s possible that could have had an impact on CMS’ authority to conduct widespread prepayment reviews.

Thursday, CMS posted this announcement on its website: “On November 15, 2011, the Centers for Medicare & Medicaid Services (CMS) announced the Prepayment Review and Prior Authorization for Power Mobility Devices (PMD) demonstration and the Recovery Audit Prepayment Review demonstration. These demonstrations were scheduled to begin on January 1, 2012. However, the CMS received many comments/suggestions regarding these demonstrations and the CMS is carefully considering these comments. Therefore, CMS will delay implementation of these demonstrations. CMS will provide at least 30 days notice before the demonstrations begin.”

CMS also delayed until further notice a demonstration project by Recovery Audit Contractors (RACs) to review certain types of high-risk claims before payment. That project was supposed to start Jan. 1, too.