August 12, 2019 SUBMITTED ELECTRONICALLY VIA Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244 Re:       CMS-6082-NC; Request for Information: Reducing Administrative Burden to Put Patients over Paperwork Dear Administrator Verma: The Center for Medicare Advocacy (“Center”) appreciates the opportunity to comment on … Read more

CMS has announced updates to its list of items of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) that will require prior authorization as a condition of payment. These new items will join 33 types of power wheelchairs that currently require prior authorization, bringing the list of DMEPOS that will require prior authorization to 45 … Read more

All Competitive Bid Program Contracts Ended on December 31, 2018. What Beneficiaries Should Know: Equipment in process under the 13 month capped rental program should continue “business as usual”. While providers who do not accept Medicare assignment cannot charge more than 15% higher than Medicare’s allowed charge. There is no such restriction (no limiting charge) … Read more

The Center for Medicare Advocacy (the Center) submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding proposed rules affecting durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The Center requested that CMS: Seek to maximize beneficiary access to DMEPOS; Clarify supplier responsibilities to provide beneficiaries with appropriate products and timely services; Develop … Read more

The Medicare-Medicaid Coordination Office’s Integrated Resource Center (ICRC) of the Center for Medicare & Medicaid Services recently released an issue brief addressing the challenges of access to durable medical equipment (DME) for dually eligible beneficiaries. The brief, Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System: Three State Approaches, … Read more

Thirty-one new items of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) will join two existing items of DMEPOS on the Center for Medicare and Medicaid Services (CMS) Master List of Items Frequently Subject to Unnecessary Utilization, requiring prior authorization as a condition of payment. All these 33 DMEPOS items are types of power wheelchairs. … Read more

On January 13, 2017 the Centers for Medicare & Medicaid Services (CMS) posted a State Informational Bulletin encouraging states to adopt strategies to improve dual eligible beneficiaries’ access to Durable Medical Equipment (DME). The Bulletin addresses a serious and persistent obstacle to obtaining DME faced by people dually eligible for Medicare and Medicaid in many states … Read more

On Friday August 19, 2016, the Center for Medicare Advocacy submitted comments in response to a June 30 request from the Centers for Medicare & Medicaid Services (CMS) for information regarding Durable Medical Equipment (DME) access issues faced by individuals who are dually eligible for Medicare and Medicaid.[1] The letter, signed by almost 80 organizations, … Read more

On June 30, 2016 the Centers for Medicare & Medicaid Services (CMS) published a proposed rule about the difficulties of dually eligible people (individuals eligible for both Medicare and Medicaid) to obtain Durable Medical Equipment (DME). The proposed rule seeks information about the problem, as well as potential solutions. The proposed rule is primarily focused … Read more

The Patient Access and Medicare Protection Act (PAMPA), enacted on December 28, 2015, delayed application of competitive bid program (CBP) adjusted payment rates for accessories furnished in connection with complex rehabilitation technology (CRT) power group 3 wheelchairs. PAMPA also included a provision requiring the General Accounting Office (GAO) to study Medicare utilization and expenditures for … Read more

On January 4, 2016, The Centers for Medicare and Medicaid Services (CMS) awarded the administration of the Jurisdiction B Durable Medicare Equipment Administrative Contractor (DME MAC) serving Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin to CGS Administrators, LLC (CGS)—an organization that is headquartered in Nashville, Tennessee. This jurisdiction was previously contracted to National Government … Read more

Effective February 20, 2016, CMS has created a prior authorization process for certain identified DMEPOS before they can be approved for Medicare payment. Items subject to prior authorization will be identified on a Master List. According to CMS, there will be no new documentation requirements, but prior authorization will help ensure that applicable coverage, payment, … Read more

On October 8, 2015 the Center for Medicare Advocacy filed a complaint with the Office of Civil Rights regarding Proposed Local Coverage Determination (LCD) DL 33787.  This proposed LCD would unfairly and illegally restrict Medicare coverage for beneficiaries in need of lower limb prostheses. The complaint was filed on behalf of Dr. Roger Catlin, an … Read more

Beneficiaries who seek Medicare coverage for expanded types and features of Speech Generating Devices (SGDs) have reason to be optimistic.  Electronic devices that meet the definition of a Speech Generating Device will be coverable.  This could include a tablet, computer, or smart phone. On April 29, 2015 the Centers for Medicare and Medicaid Services (CMS) … Read more

CMS Rescinds Restrictive Policy and Will Reconsider Technological Advances CMS announced yesterday that it has begun the process of updating its Medicare coverage policy for Speech Generating Devices (SGDs). A new SGD National Coverage Determination (NCD) is expected to be completed by July 31, 2015.  While CMS considers a new coverage rule for SGDs, it … Read more

Report prepared by Mario Ramsey, Center for Medicare Advocacy Summer Health Policy Fellow I.                   Introduction Since the introduction of the Competitive Bidding Program (CBP), trade organizations––representing the billion dollar Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) industry––have been opposed to Medicare's congressionally mandated competitive bidding program.  In keeping with this opposition, supplier organizations were … Read more CMS is currently reviewing its SGD policies. We are hopeful that CMS will revise these policies to allow SGD users to keep their speech when they’re admitted into health care facilities and be able to use their SGDs to communicate with the outside world. However, in the event CMS does not reach an acceptable … Read more

The Centers for Medicare & Medicaid Services (CMS) is charged with the implementation and oversight of the DMEPOS program.[1]  Since the rollout of the DMEPOS competitive bidding program (CBP) in July, 2008, there has been confusion over what constitutes delivery and set-up of specific DMEPOS items.[2]  In some instances, beneficiaries have experienced delays in obtaining … Read more

To: Medicare Beneficiary Advocates From: Mario D. Ramsey, CMA Health Policy Fellow Subject: GAO and OIG Reports Note No Problems In Beneficiary Access to DMEPOS.  Beneficiary Advocates Disagree. Date: July 8, 2014 Advocates' Concerns about the DMEPOS Reports Advocates are concerned that some suppliers are not delivering and setting-up necessary items of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).[1] … Read more

June 26, 2014 Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program was enacted by Congress as a cost and fraud protection measure.  From its inception, there have been questions about the program's complexity and fairness, and whether it would hinder beneficiary access to necessary DMEPOS items and services.  Background information about … Read more

Technology can help the most vulnerable among us live with more capabilities than we would have considered possible, even a few short years ago.  Rather than encourage technological advances that promote independence and safety, however, the Centers for Medicare & Medicaid Services (CMS) is reducing access to technology in an ill-conceived effort to control short-term … Read more

On July 1, 2013, Medicare Part B will implement a national mail-order competitive bidding program specifically for diabetic testing supplies. [1],[2]  The program applies to all zip codes in the 50 United States, the District of Columbia, Puerto Rico, U.S. Virgin Islands, Guam and American Samoa.[3] Once implemented, beneficiaries in traditional Medicare[4] will purchase diabetic … Read more

Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program is once again under attack.  Many questions have been raised about whether the program is fair to providers and whether beneficiaries will be able to obtain needed DMEPOS items.  Since its inception, the program has been repeatedly started and stopped by Congress.  While … Read more

On May 9, 2012, the Center for Medicare Advocacy (the Center) testified before the Subcommittee on Health, Committee on Ways and Means, U. S. Congress.  The Subcommittee hearing was called by its Chair, Wally Herger (R-CA), to explore the implementation of the Congressionally-mandated Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) competitive bidding program. Alfred … Read more

On August 19, 2011, the Centers for Medicare & Medicaid Services (CMS) announced Round 2 of its DMEPOS competitive bidding program.[1]  Bidding is to begin in January 2012.  Round 2 adds more product categories for competitive bidding and expands the number of competitive bidding areas (CBAs) affected. CMS also announced on August 19ththat it will … Read more

This article, a 38 page .pdf file from the William Mitchell Law Review (37 William Mitchell Law Review 132-169 (2010)) discusses the general process for obtaining Medicare coverage for durable medical equipment (DME) and the specific requirements for Medicare coverage of power operated vehicles (POVs) and scooters used as wheelchairs, including the Advance Determination of … Read more

When it comes to obtaining Medicare coverage for Mobility Assistive Equipment (MAE),[1] coverage criteria, particularly patient assessment standards, continue to be misunderstood by providers and beneficiaries.  The spectrum of fraud and abuse complicates matters.  In addition, over the last several years, the Centers for Medicare & Medicaid Services (CMS) has modified its rules for covering … Read more