DME Provisions Included in President’s 2015 Budget

President Obama released his 2015 budget this week, and, as expected, provisions targeting DME were included. Two of the prominent provisions suggest using Medicare bid rates for Medicaid reimbursement to save money, and implementing prior authorization as a means of fighting fraud.

AAHomecare has strongly opposed the Medicaid proposal for a number of years and has successfully kept it from going into effect. Members can read the issue paper written by our government affairs experts.

According to the proposed budget, “…States have experienced challenges in preventing overpayments for durable medical equipment (DME). Starting in 2015, the Budget would limit Federal reimbursement for a State’s Medicaid spending on certain DME services to what Medicare would have paid in the same State for the same services.”

The prior authorization demonstration project for power mobility devices began on September 1, 2012, so we have almost a year and a half experience with the program. AAHomecare is working with CMS to make necessary changes, and continues to advocate for improvements. However, the budget proposal is very vague, so it’s unclear how it would be implemented.

Specifically, the budget proposes to “implement new initiatives to reduce improper payments in Medicare; require prior authorization for power mobility devices and advanced imaging, which could be expanded to other items and services at high risk of fraud and abuse.”

The President’s budget also includes the following statement, “Modify the documentation requirement for face-to-face encounters for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims.” AAHomecare is in the process of seeking clarification from CMS on the specifics of this, as well as the other, provisions.

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