United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2015_register executive 2015-12-30 article Part II Rules and Regulations D09002ee1c7f6b84b D09002ee1c7f6b91d United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This final rule establishes a prior authorization program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are frequently subject to unnecessary utilization. This rule defines unnecessary utilization and creates a new requirement that claims for certain DMEPOS items must have an associated provisional affirmed prior authorization decision as a condition of payment. This rule also adds the review contractor's decision regarding prior authorization of coverage of DMEPOS items to the list of actions that are not initial determinations and therefore not appealable. 80 FR 81674 https://www.govinfo.gov/app/details/FR-2015-12-30/2015-32506 2015-32506 fr30de15-11 RIN 0938-AR85 4120-01-P CMS-6050-F https://www.govinfo.gov/app/details/FR-2015-12-30/2015-32506 https://www.govinfo.gov/content/pkg/FR-2015-12-30/html/2015-32506.htm https://www.govinfo.gov/content/pkg/FR-2015-12-30/pdf/2015-32506.pdf Administrative Practice and Procedure Health Facilities Health Professions Kidney Diseases Medical Devices Medicare Reporting and Recordkeeping Requirements Rural Areas X-Rays 34 p. 81674 81707 80 FR 81674 Title 42 Part 405 42 CFR Part 405 Title 42 Part 414 42 CFR Part 414 RIN 0938-AR85 Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; Federal Register Vol. 80, Issue RULE 2015-32506 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2016-02-29 CMS-6050-F 4120-01-P 2015-32506 Final rule.

This final rule establishes a prior authorization program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are frequently subject to unnecessary utilization. This rule defines unnecessary utilization and creates a new requirement that claims for certain DMEPOS items must have an associated provisional affirmed prior authorization decision as a condition of payment. This rule also adds the review contractor's decision regarding prior authorization of coverage of DMEPOS items to the list of actions that are not initial determinations and therefore not appealable.

These regulations are effective February 29, 2016. Maria Ciccanti, (410) 786-3107. Administrative Practice and Procedure Health Facilities Health Professions Kidney Diseases Medical Devices Medicare Reporting and Recordkeeping Requirements Rural Areas X-Rays Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies , http://www.bls.gov/oes/current/oes292071.htm http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/abn_booklet_icn006266.pdf http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports-Items/Downloads/AppendicesMedicareFee-for-Service2014ImproperPaymentsReport.pdf?agree=yes&next=Accept http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/MedicalReview/Downloads/PMDDemoDecemberStatusupdate12302014.pdf http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/index.html http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf404178 http://www.whitehouse.gov/omb/circulars_default/ https://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME15-A.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c30.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports-Items/Medicare-FeeforService-2014-Improper-Payments-Report.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/PMDDemoDecemberStatusupdate12302014.pdf https://www.federalregister.gov/articles/2015/07/15/2015-17365/medicare-program-extension-of-medicare-prior-authorization-for-power-mobility-devices-pmds https://www.medicare.gov/claims-and-appeals/file-a-complaint/durable-medical-equipment/complaints-about-dme.html www.sba.gov/content/table-small-business-size-standards Vol. 80, no. 250 Office of the Federal Register, National Archives and Records Administration 2015-12-30 continuing daily deposited born digital 306 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2015-12-30 P0b002ee18e374cc3 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr30de15 https://www.govinfo.gov/app/details/FR-2015-12-30 https://www.govinfo.gov/content/pkg/FR-2015-12-30/pdf/FR-2015-12-30.pdf https://www.govinfo.gov/content/pkg/FR-2015-12-30/xml/FR-2015-12-30.xml fdlp 81439 81736 DGPO 2015-12-30 2024-06-02 FR-2015-12-30 machine generated eng FR FR-2015-12-30 80 250