CMS Pub. 100-04, ch. 20, § 100.3

B-02-031

The Paperwork Reduction Act (PRA) of 1995 §44 USC 3500, et seq. requires that the

Director of the Office of Management and Budget approve any collections of information

performed by or for the Federal Government unless the collection fits within exceptions

for audits and investigations. Absent such approval, the collection violates the PRA and

agencies may not hold the public to the requirement. Therefore, DME MACs must

adhere to the following:

1. Power operated vehicles additional documentation requirements

A Certificate of Medical Necessity (CMN) must accompany initial claims for power

operated vehicles (POV). Except during the course of audits and investigations, DME

MACs must not require that additional documentation accompany all POV claims. DME

MACs may continue requesting information during the course of audits and

investigations and when developing individual claims on either a pre- or a post-payment

basis. If DME MACs choose to conduct such investigations, they must follow the

guidelines in the Program Integrity Manual, Chapter 3.

2. Power wheelchair additional documentation requirements re: make and model

name/number

There must be no requirement that all claims for power wheelchairs include the make and

model name/number of the wheelchair separate from the claim or the CMN.

The CMN, an OMB approved information collection form, can be used to collect this

information. Specifically, DME MACs can require that the make and model name/

number of the power wheelchair be included in Section C of the CMN. Section C

requires the supplier to include a narrative description of the items, options and

accessories ordered.

3. Power wheelchair additional documentation requirements re: functional abilities

There must be no requirement for suppliers to submit additional documentation to

describe a beneficiary's medical condition and functional abilities when the supplier bills

for a higher level of equipment than previously supplied.

While it is appropriate to avoid paying for duplicate equipment, it is inappropriate to

require this documentation for all claims for "higher level equipment." DME MACs may

choose to perform pre- or post- payment probe samples to review these types of claims

individually in order to determine medical necessity. If DME MACs choose to conduct

such investigations, they must follow the guidelines in the Program Integrity Manual,

Chapter 3.