Sec. 4005. Extension and expansion of prior authorization for power mobility devices (PMDs) and accessories and prior authorization audit limitations
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Section 1834(a) of the Social Security Act ( 42 U.S.C. 1395m(a) ) is amended— in paragraph (15), by adding at the end the following new subparagraph: A claim for an item that has received a provisional affirmation under an advance determination under this paragraph or a prior authorization under paragraph
(23)shall not be subject to review under section 1893(h) but may be subject to audits for potential fraud, inappropriate utilization, changes in billing patterns, or information that could not have been considered during the advance determination (such as proof of item delivery). ; and by adding at the end the following new paragraph: Not later than 90 days after the date of the enactment of this paragraph, the Secretary shall, using funds provided under paragraph
(2)of section 402(a) of the Social Security Amendments of 1967 and other funds available to the Secretary— extend at least through August 31, 2018, the PMD Prior Authorization Demonstration (being conducted under paragraph (1)(J) of such section); begin to expand, as appropriate, such demonstration to include additional power mobility devices and accessories as part of initial claims for payment under this part for such devices; and begin to expand such demonstration to such additional States or geographic areas as may be appropriate. .
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Sec. 4005
Extension and expansion of prior authorization for power mobility devices (PMDs) and accessories and prior authorization audit limitations
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