New legislation builds upon previous prior authorization legislation.

Via AAHomecare—WASHINGTON, D.C. (May 17, 2017)—We have just received confirmation that Congresswoman Marsha Blackburn (R-Tenn.) has formally introduced legislation that would require prior authorization for certain home medical equipment items in higher price ranges. The formal title for HR 2445 will be the DMEPOS Access and Transparency Act of 2017, and may also be referred to as the DATA Act of 2017.

The new legislation builds upon previous prior authorization legislation championed by Rep. Blackburn, and includes new provisions that require medical necessity for respiratory equipment. Other key provisions of the bill include (italicized text is taken directly from a final draft of the legislation):

Not later than 1 year after the date of the enactment of this subparagraph, the Secretary shall develop and implement a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies. A claim for an item of durable medical equipment, a prosthetic, an orthotic, or a supply that has received prior approval through the prior authorization process shall be exempt from subsequent pre- and post-payment audits and only subject to audits for systematic fraud and abuse.

The Secretary shall consider the following factors in developing and implementing the prior authorization process:
(I) Beneficiary access to timely care.
(II) Alignment with the best practices of commercial managed care plans and Medicare Advantage plans under part C that have expertise in prior authorization processes.
(III) Implementation of standard medical necessity evaluation prior authorization requests for physician and hospital referral agents and non-physician practitioners.
(IV) Accounting for same day delivery expectations by providing for expedited emergency review for certain items.

“This legislation will help stem the tide of Medicare audits that delay payments for providers and also tie up significant resources as providers answer and appeal them,” said Tom Ryan, president and CEO of AAHomecare. “We applaud Congresswoman Blackburn’s longstanding efforts to help rein in excessive audits by establishing an effective prior authorization process that will both improve cash flow for providers and also allow them to concentrate more of their resources and energy on serving their patients.”

A draft of the legislation is available here. AAHomecare will provide additional perspective on the legislation and how the HME community can support it shortly.

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