Traditional Medicare Provider Payment—Assistive Technology and Durable Medical Equipment

Background

Under Part B, MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). covers many types of medically necessary assistive technologies that improve health and functioning, including durable medical equipment ( DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. ), prosthetics, orthotics, and supplies. The most common types of DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. are mobility devices such as wheelchairs and walkers. Newer or less familiar 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 DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. suppliers have engaged in fraud and abuse. The Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services has imposed supplier conditions to address this problem, including surety bonds, criminal background checks, and unannounced site visits. Since 2009, with some exceptions, DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. suppliers must be accredited and post a surety bond. The Affordable Care Act requires that providers have face-to-face visits with beneficiaries to determine medical necessity before the need for power wheelchairs and other DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. items can be certified. In addition, DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. suppliers must undergo fingerprinting, criminal background checks, and unannounced site visits. The Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services (CMS) may withhold DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. payments for 90 days when investigating suspected fraud.

To slow the growth of MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). spending, most suppliers of durable medical equipment, prosthetics, orthotics, and supplies, known commonly as DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. , must submit competitive bids. CMS estimated that competitive bidding reduced MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). spending on DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. by 42 percent in 2012, its first year of operation. It is estimated that it will save almost $26 billion over ten years. Initially, observers were concerned that requiring competitive bidding could negatively affect beneficiaries. But early indications are that access to DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. and health outcomes have not suffered. In 2017, total MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). spending on competitively bid DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. supplies was $4.7 billion less than in 2010 ($2.8 billion compared with $7.5 billion), and median payment rates for the 25 highest-spending DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. supplies declined by nearly 50 percent.

TRADITIONAL MEDICARE PROVIDER PAYMENT—ASSISTIVE TECHNOLOGY AND DURABLE MEDICAL EQUIPMENT: Policy

TRADITIONAL MEDICARE PROVIDER PAYMENT—ASSISTIVE TECHNOLOGY AND DURABLE MEDICAL EQUIPMENT: Policy

Access and integrity

The Department of Health and Human Services (HHS) should continue to monitor and control the incidence of fraud and abuse associated with durable medical equipment, commonly called DMEEquipment ordered by a health care provider for everyday or extended use. Insurance coverage for DME may include: oxygen equipment, wheelchairs, hospital beds, walkers, blood testing and monitoring devices. , and monitor MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). beneficiaries’ access to durable medical equipment, prosthetics, orthotics, and supplies or DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. .

HHS should strictly enforce regulations on accrediting and minimum quality standards for DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. suppliers in order to deter unnecessary utilization of devices while ensuring MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). beneficiaries have access to safe, high-quality, medically necessary, and appropriate DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. .

Competitive bidding should continue to be used for pricing all DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. . Quality and access should not be compromised by the competitive bidding process.

HHS should ensure that the competitive bidding process includes exact individual specifications for DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. . The agency also should monitor and publicly report on whether MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). beneficiaries are receiving the appropriate quality of service and value from their DMEPOSInitialization of durable medical equipment, prosthetics, orthotics, and supplies. , as indicated by safety, cleanliness, and cost (see also Product Safety in the Home).