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CMS Gives “Scooter” Demo Expansion the Green Light

The Centers for Medicare and Medicaid Services (CMS) is expanding the prior authorization demonstration program for powered mobility devices (PMDs) to include 12 additional states for a total of 19.  New York was one of the seven original states in the 3-year demo which began Sept. 2012, and New York will continue to participate.  The additional states will come on board effective Oct. 1. 2014.  The demonstration will end on Aug. 31, 2015 for all states.

The demonstration implements a prior authorization process for PMDs for Medicare beneficiaries.  The prior authorization request may be completed by the physician/practioner or Durable Medical Equipment (DME) supplier for review by the DME Medicare Administrative Contractor (MAC).

Medlearn Matters Article SE1231 provides additional details on the demonstration, along with important guidance on the definition of PMD versus a Powered Operated Vehicle (POV), and the billing codes for PMDs.  CMS also has a web page and PMD fact sheet that covers the standards and procedures for ordering the devices. 

PMDs as a Medicare benefit generated some controversy as the demand for the higher end and more sophisticated PMDs began to rise several years ago, and in response CMS held payment for this benefit in abeyance pending further study.  As payment for the benefit resumed in 2006, CMS designed this demonstration program to help minimize fraud in the system.  CMS believes that the early experience with the demonstration has been successful, and hence is expanding the number of states covered.  CMS has also incorporated into the demonstration improved methods for the investigation and prosecution of fraud in the provision of care or services under the health programs established by the Social Security Act.

PMDs can be a great benefit to individuals, both in community and institutional settings, whose activities of daily living (ADLs) are negatively impacted by mobility restrictions.  Especially in institutional or closed-community settings members continue to refine the appropriate use of PMDs, as they can sometimes present an unsafe situation or an annoyance to  non-users.  These settings clearly require that organizations establish “rules of the road” that ensure the safety and rights of both the user and non-user.  Our Continuing Care Retirement Community (CCRC), Housing and Retirement Housing Cabinets have each been sharing best practices in this area.   As part of the legal update at our recent CCRC Summer Summit, LeadingAge NY offered a session on PMDs that included consideration of the Americans with Disabilities Act (ADA) in the development of PMD policies and procedures. 

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827