CMS Proposes Rule To Expand Authorization Program, Solicits Comments On Implementation

On May 28, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) published a proposed rule to establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) items under the limited authority granted by Social Security Act § 1834(a)(15).  The proposed rule seeks to create an annually self-updating, Master List of items that could require prior authorization.  Master List items include more than 135 HCPCS, including HCPCS for continuous airway pressure devices, power wheelchairs and certain support surfaces.  To be included on the Master List, an item must have a costly purchase or rental fee, as well as a high rate of "unnecessary utilization" or history of "improper payments," as identified under certain government audit programs.  CMS plans to initially implement the program using a subset of items on the Master List to develop a Required Prior Authorization List,