Medicare covers many types of assistive technologies that improve health and functioning if they are medically necessary, including durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS), which are reimbursed under Medicare Part B. The most common types of DME are mobility devices such as wheelchairs and walkers. Newer or less well-known forms of assistive technology, such as speech generators, may not be covered even when medically necessary because of questions about their clinical efficacy or appropriate use.
Some DME suppliers have engaged in fraud and abuse, and CMS has taken steps to deal with this problem. Since 2009, with some exceptions, DME suppliers must be accredited and post a surety bond. The ACA imposed the requirement that a provider have a face-to-face visit with a beneficiary to determine medical necessity before the need for power wheelchairs and other DME items can be certified. In addition, DME suppliers are subject to fingerprinting, criminal background checks, and unannounced site visits. CMS may withhold DME payments for 90 days when investigating suspected fraud.
To slow the growth of Medicare spending, most DMEPOS suppliers must submit competitive bids. CMS has estimated that competitive bidding, in its first year of operation (2012), has reduced Medicare spending on DMEPOS by 42 percent, and that it will save almost $26 billion over 10 years. Initially observers were concerned that requiring competitive bidding could negatively affect beneficiaries, but early indications are that access to DMEPOS and health outcomes have not suffered.
Traditional Fee-for-Service Medicare/Provider Payment—Assistive Technology and Durable Medical Equipment: Policy
Access and integrity
AARP supports the reforms implemented to reduce fraud and abuse associated with DME. HHS should continue to monitor and control the incidence of fraud and abuse associated with DME, while also monitoring Medicare beneficiaries’ access to DMEPOS.
HHS should strictly enforce regulations on accrediting and minimum quality standards for DMEPOS suppliers in order to deter unnecessary utilization of devices, while ensuring Medicare beneficiaries have access to safe, high-quality, medically necessary, and appropriate DMEPOS.
Competitive bidding should be used for pricing all DMEPOS, as long as quality and access are not compromised by the competitive bidding process.
HHS should ensure that the competitive bidding process includes exact individual specifications for DMEPOS. The agency also should monitor and publicly report on whether Medicare beneficiaries are receiving appropriate quality of service and value from their DMEPOS, as indicated by safety, cleanliness, and cost. (See also Product Safety in the Home)