Moving the HME Industry Forward

Legislative/Advocacy

Hard Work and Persistence Pays Off for PMD Prior Authorization​

June 8, 2018

WASHINGTON, DC – As reported last week, CMS will be expanding the Prior Authorization Demonstration for Power Mobility Devices nationwide on a permanent basis, starting Sept. 1, 2018. This move adds 31 Power Mobility HCPCS codes to Medicare’s DME Prior Authorization program, joining power wheelchair codes K0856 and K0861 that were already subject to prior authorization.

Members of AAHomecare’s Complex Rehab & Mobility Council and Regulatory Council, who have worked with CMS to refine the program, are pleased to see their efforts come to fruition:

“Prior authorization makes good sense for the patient, the supplier and the government’s budget,” says Georgie Blackburn, vice president of government relations for BLACKBURNS.  “Our industry worked hard to illustrate the benefits and CMS listened, and, more importantly, responded with workable timelines. That’s progress we can build upon!”

Jackie Semrad, corporate compliance officer with Reliable Medical Supply, echoed those sentiments: “The expansion of the PMD prior authorization program is something we have wanted for a long time!  AAHomecare and other HME stakeholders have been working on this for years, and it’s satisfying to see those efforts pay off in a policy that will benefit everyone involved.”

“Prior authorization for PMD is a positive for CMS because they can ensure medical necessity and hopefully reduce the number of post pay audits,” adds Semrad. “It will help DME providers by ensuring that equipment delivered to the patient will likely get paid. But most importantly, it will benefit Medicare beneficiaries and their caregivers by clearly informing them whether or not their wheelchair is covered.”

This policy win is the latest example of the essential work undertaken by AAHomecare members who bring expertise and dedication to their service on the Association’s councils and work groups. Those interested in learning more about joining the Complex Rehab & Mobility Council, the Home Medical Equipment/Respiratory Therapy Council, or the Medical Supplies Council, contact Ashley Plauche at ashleyp@aahomecare.org.

AAHomecare Adjusts Supplier Tracking Based on CMS Data Changes

WASHINGTON, DC – Since 2015, AAHomecare has been tracking the number of suppliers and their locations to monitor the impact of competitive bidding and other factors on the industry. Our analysis has helped to bring these issues to the attention of Congressional offices and HHS to illustrate the need for more sustainable Medicare reimbursement rates and bidding program reforms. We have seen some progress on these fronts, most notably in last month’s IFR where CMS for the first time acknowledged the decline in the number of suppliers.

To conduct our analysis, we have been using the supplier directory that is available on CMS’ website. However, last year after we published our July 2017 analysis, we were notified of changes to the supplier directory, which resulted in new numbers not corresponding to previous analysis. To help us maintain consistency of the data, AAHomecare changed to a process of requesting CMS data via the Freedom of Information Act (FOIA) to capture the true state of the DME industry.

With the FOIA data, our latest analysis shows a 33% decrease in the number of unique traditional DME suppliers since the beginning of competitive bidding and a 31% decrease in the number of traditional DME supplier locations. Analysis does not include big merchandisers such as Walmart and Kmart, but rather suppliers deemed as “traditional” suppliers. AAHomecare identifies “traditional” suppliers as companies that provide at least two of the following product categories: oxygen, CPAP, NPWT, RAD, hospital beds, wheelchair and accessories, urological supplies, enteral supplies, and ostomy supplies.

Moving forward, AAHomecare will be continuing its quarterly supplier number analysis using our new data source. We appreciate the supplier community’s patience on this initiative and we look forward to continuing to provide useful analysis. While we feel more confident with our new methodology, we want to emphasize that these are still estimates based on the sources that are available to us. We are always continuing to improve our monitoring efforts and we appreciate our membership’s support of this initiative.  Find latest analysis here.