Ppr Int 9E7F77273Af84Af7 Durable Medical Equipment Prosthetics Orthotics And Supplies Pdf - Ppr Int 9E7F77273Af84Af7 Durable Medical.
Summary
CMS fact sheet dated 05/10/2023, “Durable Medical Equipment, Prosthetics, Orthotics and Supplies: CMS Flexibilities to Fight COVID-19”, listing the Medicare and Medicaid flexibilities for DMEPOS suppliers during the COVID-19 public health emergency and what becomes of each when it ends. It says CMS resumed prior authorization for Power Mobility Devices and Pressure Reducing Support Surfaces on August 3, 2020, and resumed supplier accreditation and the three waived supplier standards effective July 6, 2020. As required by section 3712 of the CARES Act, CMS adjusts fee schedule amounts with a 50/50 blend of rates in rural and non-contiguous areas, extended past the emergency by rulemaking, and a 75/25 blend in other areas. Enrollment waivers on fingerprint checks, application fees and revalidation ended on 10/31/2021.
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“Ppr Int 9E7F77273Af84Af7 Durable Medical Equipment Prosthetics Orthotics And Supplies Pdf - Ppr Int 9E7F77273Af84Af7 Durable Medical.”
Original at www.cms.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/ppr-int-9e7f77273af84af7-durable-medical-equipment-prosthetics-orthotics-and-supplies-pdf-5db6a08af9/
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Durable Medical Equipment, Prosthetics, Orthotics and Supplies:
CMS Flexibilities to Fight COVID-19
At the beginning of the COVID-19 Public Health Emergency (PHE), CMS used emergency waiver
authorities and various regulatory authorities to enable flexibilities so providers could rapidly
respond to people impacted by COVID-19. CMS developed a cross-cutting initiative to use a
comprehensive, streamlined approach to reestablish certain health and safety standards and
other financial and program requirements at the eventual end of the COVID-19 public health
emergency.
This CMS cross-cutting initiative focused on evaluating CMS-issued PHE waivers and flexibilities
to prepare the health care system for operation after the PHE. This review happened in three
concurrent phases:
1. CMS assessed the need for continuing certain waivers based on the current phase of the
PHE. Since the beginning of the PHE, CMS has both added and terminated flexibilities and
waivers as needed. In doing so, CMS considered the impacts on communities — including
underserved communities — and the potential barriers and opportunities that the
flexibilities may address.
2. CMS assessed which flexibilities would be most useful in a future PHE, such as natural and
man-made disasters and other emergencies, to ensure a rapid response to future
emergencies, both locally and nationally, or to address the unique needs of communities
that may experience barriers to accessing health care.
3. CMS is continuing to collaborate with federal partners and the health care industry to
ensure that the health care system is holistically prepared for addressing future
emergencies.
As CMS identified barriers and opportunities for improvement, the needs of each person and
community served were considered and assessed with a health equity lens to ensure our
analysis, stakeholder engagement, and policy decisions account for health equity impacts on
members of underserved communities and health care professionals disproportionately serving
these communities.
Please note: This fact sheet focuses on Medicare and Medicaid flexibilities only.
• Where Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) are
lost, destroyed, irreparably damaged, or otherwise rendered unusable, DME Medicare
Administrative Contractors have the flexibility to waive replacement requirements
05/10/2023 1
under Medicare, such that the face-to-face requirement, a new physician’s order, and
new medical necessity documentation are not required. Suppliers must still include a
narrative description on the claim explaining the reason why the equipment must be
replaced and are reminded to maintain documentation indicating that the DMEPOS was
lost, destroyed, irreparably damaged, or otherwise rendered unusable or unavailable as
a result of the emergency.
• Prior Authorization in DMEPOS: CMS previously paused certain prior authorization
requirements for claims for Power Mobility Devices and Pressure Reducing Support
Surfaces. CMS additionally delayed the prior authorization requirement for specified
Lower Limb Prosthetics. On August 3, 2020, CMS resumed full operations for the prior
authorization of Power Mobility Devices and Pressure Reducing Support Surfaces.
Additionally, CMS phased in prior authorization requirements for certain Lower Limb
Prosthetics in late 2020.
• DMEPOS Accreditation: During the initial stage of the PHE, CMS did not require
accreditation for newly enrolling DMEPOS suppliers and extended any expiring supplier
accreditation for a 90-day time period. Effective July 6, 2020, CMS resumed all
accreditation and reaccreditation activities for DMEPOS suppliers, including associated
surveys.
• DMEPOS Supplier Standards: During the initial stage of the PHE, CMES waived three
DMEPOS supplier standards. See below. Effective July 6, 2020, CMS resumed
enforcement of the three temporarily waived supplier standards.
o 42 CFR § 424.57(c)(7): Physical access—maintains a physical facility on an
appropriate site.
o 42 CFR § 424.57(c)(9): Business Phone—maintains a primary business telephone
that is operating at the appropriate site listed under the name of the business
locally or toll-free for beneficiaries.
o 42 CFR § 424.57(c)(30)(i): Minimum hours of operation—except as specified in
42 CFR § 424.57(c)(30)(ii), is open to the public a minimum of 30 hours per week.
• DMEPOS Payment Increases: As required by section 3712(a) of the Coronavirus Aid,
Relief, and Economic Security (CARES) Act, CMS will continue to adjust the fee schedule
amounts for items and services furnished in rural and non-contiguous, non-competitive
bidding areas within the U.S., based on a 50/50 blend of adjusted and unadjusted rates
through the remainder of the public health emergency for COVID-19. Through notice-
and-comment rulemaking (86 FR 73860, 87 FR 199), CMS has extended the 50/50 blend
of adjusted and unadjusted rates in rural and non-contiguous, non-competitive bidding
areas after the public health emergency. Also, as required by section 3712(b) of the
CARES Act, CMS will continue to adjust the fee schedule amounts for certain DMEPOS
items and services furnished in non-rural, non-competitive bidding areas within the
05/10/2023 2
contiguous U.S., based on a 75/25 blend of adjusted and unadjusted rates through the
remainder of the public health emergency for COVID-19. More information on these
changes can be found on the CMS DME Center website:
https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.
• Signature Requirements: CMS has waived signature and proof of delivery requirements
for Part B drugs and Durable Medical Equipment when a signature cannot be obtained
because of the inability to collect signatures for the duration of the public health
emergency for COVID-19. Suppliers document in the medical record the appropriate
date of delivery and that a signature was not able to be obtained because of COVID-19.
After the PHE, signature and proof of delivery requirements will be reinstated.
• Signature on Orders: DMEPOS items, except for Power Mobility Devices (PMDs) and
other items on the Face-to-Face and Written Order Prior to Delivery List, can be
provided via a verbal order. A signature is required prior to submitting claims for
payment. PMDs and other items on the Face-to-Face and Written Order Prior to Delivery
List require a signed, written order prior to delivery. Orders can be signed electronically.
• COVID-19 Accelerated and Advance Payments (CAAP): For the most up to date
information related to the CAAP Program, please visit
https://www.cms.gov/medicare/covid-19-accelerated-and-advance-payments
• Provider Enrollment: During the PHE, CMS has established toll-free hotlines for
physicians, non-physician practitioners, and Part A certified providers and suppliers who
have established isolation facilities to enroll and receive temporary Medicare billing
privileges. When the PHE ends, the hotlines will be shut down. Additionally, CMS has
provided the following flexibilities for provider enrollment:
o Screening requirements:
• Site Visits: CMS waived provider enrollment site visits for moderate and high-
risk providers/suppliers. (This waiver terminated on 07-06-2020 and CMS, in
accordance with 42 CFR §§ 424.517 and 424.518, resumed all provider
enrollment site visits.)
• Fingerprint-based criminal background checks: CMS waived the requirement
for fingerprint-based criminal background checks for 5% or greater owners of
newly enrolling high-risk categories of providers and suppliers (e.g., newly-
enrolling Home Health Agencies, DMEPOS suppliers, Medicare Diabetes
Prevention Programs, Opioid Treatment Programs). (This waiver terminated
on 10/31/2021, and CMS, in accordance with 42 CFR § 424.518, resumed
requesting fingerprints for all newly enrolling high-risk providers and
suppliers.)
05/10/2023 3
o Application Fees: CMS waived the collection of application fees for institutional
providers who are initially enrolling, revalidating, or adding a new practice location.
(This waiver terminated on 10/31/2021 and CMS, in accordance with 42 CFR §
424.514, resumed collecting application fees.)
o Revalidation: CMS postponed all revalidation actions. This did not prevent a provider
who wanted to submit a revalidation application from doing so; MACs processed
revalidation applications. (This waiver terminated on 10/31/2021, and CMS
resumed a phased-in approach to revalidation activities; revalidation letters began
being mailed again in November 2021 with due dates in early 2022.)
o Expedited Enrollment: CMS expedited any pending or new applications from
providers and suppliers, including physicians and non-physician practitioners
received on or after March 1, 2020. When the PHE ends, CMS will resume normal
application processing times.
Medicare appeals in Traditional Medicare, Medicare Advantage (MA) and Part D
• During the PHE, CMS has been allowing Medicare Administrative Contractors (MACs)
and Qualified Independent Contractor (QICs) in the FFS program (42 CFR 405.942 and 42
CFR 405.962) and MA and Part D plans, as well as the Part C and Part D Independent
Review Entity (IREs) (42 CFR 422.582 and 42 CFR 423.582), to allow extensions to file an
appeal. Specifically, 42 CFR 422.582(c) and 42 CFR 423.582(c) allow a Part C or Part D
plan to extend the timeframe for filing a request if there is good cause for the late filing.
In addition, the Part D IRE may find good cause for late filing of a request for
reconsideration. When the COVID-19 PHE ends, these flexibilities will continue to
apply consistent with existing authority and requests for appeals must meet the
existing regulatory requirements.
• During the PHE, CMS has been allowing MACs and QICs in the FFS program (42 CFR 405.
950 and 42 CFR 405.966), and the Part C and Part D IREs to waive requirements for
timeliness for requests for additional information to adjudicate appeals. In addition,
under applicable regulations, MA plans may extend the timeframe to adjudicate
organization determinations and reconsiderations for medical items and services (but
not Part B drugs) by up to 14 calendar days if: the enrollee requests the extension; the
extension is justified and in the enrollee's interest due to the need for additional
medical evidence from a noncontract provider that may change an MA organization's
decision to deny an item or service; or, the extension is justified due to extraordinary,
exigent, or other non-routine circumstances and is in the enrollee's interest (42 CFR
422.568(b)(1)(i), 42 CFR 422.572(b)(1) and 42 CFR 422.590(f)(1)). When the COVID-19
PHE ends, these flexibilities will continue to apply consistent with existing authority
and requests for appeals must meet the existing regulatory requirements.
05/10/2023 4
• During the PHE, CMS has been allowing MACs and QICs in the FFS program (42 CFR
405.910) and MA and Part D plans, as well as the Part C and Part D IREs, to process an
appeal even with incomplete Appointment of Representation forms (see 42 CFR 422.561
and 42 CFR 423.560 for definitions of “representative”). However, any communication
was sent only to the beneficiary. When the COVID-19 PHE ends, this flexibility will
continue to apply, consistent with existing guidance for the MACs and QIC in the FFS
program. For MA and Part D plans, as well as the Part C and Part D IREs, this flexibility
will no longer apply. The MA and Part D plans, as well as the Part C and D IREs, must
process the appeals based on regulatory requirements (42 CFR 422.582(f)-(g), 42 CFR
423.582(e)-(f), 42 CFR 422.592(d)-(e), and 42 CFR 423.600(g)-(h)).
• During the PHE, CMS has been allowing MACs and QICs in the FFS program (42 CFR 405.
950 and 42 CFR 405.966) and MA and Part D plans, as well as the Part C and Part D IREs,
to process requests for appeal that don’t meet the required elements but instead use
information that is available (42 CFR 422.562 and 42 CFR 423.562). When the COVID-19
PHE ends, requests for appeals must meet the existing regulatory requirements.
• During the PHE, CMS has been allowing MACs and QICs in the FFS program (42 CFR 405.
950 and 42 CFR 405.966) and MA and Part D plans, as well as the Part C and Part D IREs,
to utilize all flexibilities available in the appeal process as if good cause requirements are
satisfied. When the PHE ends, these flexibilities may only be provided consistent with
existing regulatory authority.
Additional Guidance
• The Interim Final Rules and waivers can be found at https://www.cms.gov/about-
cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-
waivers.
05/10/2023 5
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