AARP Hearing Center
Background
Under Part B, Medicare covers many medically necessary assistive technologies that improve health and functioning. Among them are durable medical equipment (DME), prosthetics, orthotics, and supplies. The most common types of DME are mobility devices such as wheelchairs and walkers. Medicare Part B covers DME that is medically necessary, prescribed by a clinician, and suitable and intended to be used at home. 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 DME suppliers have engaged in fraud and abuse. The Centers for Medicare & Medicaid Services has imposed supplier conditions to address this problem, including surety bonds, criminal background checks, and unannounced site visits. Since 2009, with some exceptions, DME suppliers must be accredited and post a surety bond.
In general, Medicare pays for DME using a fee schedule. To slow the growth of Medicare spending, in 2011, CMS implemented a competitive bidding program for many DME items, such as wheelchairs and hospital beds. In 2019, CMS suspended the program. A more limited program was resumed in 2021.
TRADITIONAL MEDICARE PROVIDER PAYMENT—ASSISTIVE TECHNOLOGY AND DURABLE MEDICAL EQUIPMENT: Policy
TRADITIONAL MEDICARE PROVIDER PAYMENT—ASSISTIVE TECHNOLOGY AND DURABLE MEDICAL EQUIPMENT: Policy
Durable medical equipment (DME) access and integrity
The U.S. Department of Health and Human Services (HHS) should continue to monitor and control the incidence of fraud and abuse associated with DME, as well as monitor Medicare beneficiaries’ access to DME, prosthetics, orthotics, and supplies (DMEPOS).
HHS should strictly enforce regulations on accrediting and minimum quality standards for DMEPOS suppliers to deter unnecessary utilization of devices. HHS should also ensure Medicare beneficiaries have access to safe, high-quality, medically necessary, and appropriate DMEPOS.
Competitive bidding should continue to be used for pricing all DMEPOS. However, the competitive bidding process should not compromise quality and access (see also Product Safety).