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Expansion of the program is likely to be quick.

Home health agencies are hoping that Medicare listens to their pleas to nix a prior authorization demonstration for the services. But if it doesn’t, they may get a hint of what the demo will be like by looking at one of the program’s guinea pigs in the area — durable medical equipment suppliers.

Reminder: The Centers for Medicare & Medicaid Services proposed a prior auth demo for home health in a brief Feb. 5 Federal Register notice. In response, CMS received more than 325 comment letters on the proposal, most of which blasted the idea for reasons ranging from increasing hospital readmissions to unnecessarily adding to provider burden with no benefit (see Eli’s HCW, Vol. XXV, No. 5).

Time will tell whether CMS heeds these comments. But the agency is moving ahead with its prior auth program for Power Mobility Devices, and the home health procedure could look very similar.

Affected states: CMS implemented its PMD prior auth demo covering a variety of wheelchairs in seven states in September 2012. The states CMS chosen were those “with high populations of fraud- and error-prone providers,” the agency explains on its prior auth demo website. They were California, Illinois, Michigan, New York, North Carolina, Florida and Texas. That group includes four of the five states CMS has proposed for the home health prior auth demo — Florida, Texas, Illinois, and Michigan. The only difference is the proposed inclusion of Massachusetts.

Clue: CMS widened the PMD demo to an additional 12 states in July 2014 — Maryland, New Jersey, Pennsylvania, Indiana, Kentucky, Ohio, Georgia, Tennessee, Louisiana, Missouri, Washington and Arizona. HHAs can expect to see a similar expansion to roughly the same states under the home health demo, experts predict.

The PMD demo was originally scheduled to end last August. In December, CMS extended the PMD demo for another three years until August 2018. At the same time, CMS finalized its rule for a nationwide permanent prior auth program (see Eli’s HCW, Vol. XXV, No. 1). While the final rule contained a list of potential prior auth DMEPOS items, it didn’t actually specify which items it would subject to the process.

Now, CMS has said it is considering two more PMD items as the first ones to undergo the process — K0856 (Power Wheelchair, Group 3 Standard, Single Power Option, Sling/Solid Seat/ Back, Patient Weight Capacity Up To And Including 300 Pounds) and K0861 (... Multiple Power Option ...).

These codes are not yet finalized, noted CMS’s Jenny McCormick in the agency’s May 4 Open Door Forum for home care providers. Neither are the program’s procedures, which CMS is hammering out now, McCormick added.

Stay tuned: Once CMS finalizes the codes, it will host provider outreach calls to gather input on the operational guidelines and incorporate the information into the operational guide for the program.

Resource: For a look at the operational guide for the PMD demo, go to .

Plus: “We understand that competitive bid may create some changes to the master list items,” McCormick said. “We are working internally to address this.”

Prior Auth Momentum Builds

CMS delayed the start date of the PMD prior auth demo for nearly a year as it ironed out wrinkles. But once the demo got started, CMS expanded the number of states involved by 171 percent less than two years later. And the final, nationwide program is expected to take effect less than four years after the demo’s start.

HHA perspective: HHAs can expect a similarly quick timeline if CMS gives home health prior auth a green light.

Note: See more about the PMD prior auth demo at and more about the DME prior auth final rule at .