By Kristin Easterling
(May 24, 2018)—Recently, the Government Accountability Office (GAO) conducted a study on Medicare prior authorization requirements. The requirements began in seven states for certain power mobility devices such as power wheelchairs in 2012. The categories later expanded to include DME, home health and others.
—Via AAHomecare—WASHINGTON, D.C. (August 16, 2017)—Last year, CMS finalized the rule to move forward with expanding the prior authorization (PA) program. Although the program has great support from the industry, AAHomecare expressed concern with the lack of physician involvement in the correspondence of the PA decision. Unlike the PMD Demonstration, under the PA expansion, DME MACs cannot automatically communicate with referring physicians on the PA decision.
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.
WASHINGTON, D.C. (June 9, 2016)—The Partnership for Quality Home Healthcare—a coalition of home health providers dedicated to improving the integrity, quality and efficiency of home health care for our nation's seniors—today expressed disappointment with the revised home health prior authorization demonstration released today by the Centers for Medicare & Medicaid Services (CMS).
WASHINGTON, D.C. (May 13, 2016)—The Partnership for Quality Home Healthcare—a coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home health care for our nation's seniors—recently expressed deep concern regarding the Centers for Medicare & Medicaid Services’ (CMS) proposal to require the prior authorization of Medicare home health services.
WASHINGTON, D.C. (January 7, 2016)—On December 29, 2015, CMS published the final rule to Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. This comes a year and a half after the proposed rule, which came out on May 28, 2014. Originally CMS proposed that the timeframe for a response to a prior authorization request would be made within 10 days or two days for expedited requests.
WASHINGTON, D.C. (January 4, 2016)—CMS Tuesday issued a final rule, “Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies,” that would establish a prior authorization process for certain DMEPOS items that they cite as frequently subject to unnecessary utilization.
WASHINGTON, D.C. (December 29, 2015)—CMS finalized the rule to implement Prior Authorization for general DMEPOS items. The final rule was published on December 29th. The proposed rule, published in May 2014, suggested that a prior authorization requirement be imposed for selected HCPCS that are frequently subject to unnecessary utilization. The originally proposed master list consisted of 139 HCPCS.
