Response to Comment Document

CMS Response to Public Comments Received for CMS-855S

The Centers for Medicare and Medicaid Services (CMS) received comments for CMS10526 from one organization. CMS acknowledges receipt of these comments. However,
these comments were submitted to the incorrect docket. CMS did receive comments
from a relevant association related to CMS-855S. This is the reconciliation of the
comments.

Comment:

The Centers for Medicare and Medicaid Services (CMS) received several comments from
an association that uses the CMS-855S (Medicare Enrollment Application - Durable
Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers).
Response:
CMS appreciates the suggestions, concerns and questions expressed by this
commenter. Each bulleted item will be addressed individually.

Comment:
1) The association " ... generally approves of CMS the 855Sforms to standardize the

information suppliers submit to demonstrate that they are eligible to enroll in
Medicare."
Response:
CMS strives to standardize enrollment information as much information as possible
given the several different types of providers and suppliers. CMS appreciates your
recognition of this.

Comment:

2) The association" .. .reiterates its previous recommendation that CMS closely monitor
suppliers enrolling in Medicare for the.first time. Suppliers ... that have no previous
history with the program should have random onsite inspections over the course of
their first five years as Medicare suppliers."
Response:

CMS, in accordance with 42 C.F.R. section 424.57(c)(8) requires all new DMEPOS
suppliers complete and pass an unannounced site inspection prior to enrollment into
the Medicare program. In addition, ad hoc site investigations are performed based
on supplier type and current fraud indicators. All DMEPOS suppliers are required
to resubmit all of their Medicare enrollment information every three years for
revalidation as required by 42 C.F.R. section 424.57(e).

Comment:
3) "Section JD adds "and Repairs'' to Related Accessories.for Standard Manual and
Power Wheelchairs, but this verbiage wasn't added to any other DME product.
Including "and repairs" for standard manual and power wheelchairs creates a new
designation that could have unintended consequences for suppliers and beneficiaries.
One unintended consequence we foresee is the potential decrease the number of
suppliers willing to.furnish standard manual and power wheelchairs. The new
language creates an inference that suppliers that furnish these wheelchairs also have
an obligation to repair them if they furnish anything other than a base chair without
any accessories, e.g., elevated leg rests, anti-tippers. in addition to the chair. "

Response:
CMS does not believe such an inference is being made. CMS believes the distinction
between the standard manual and power wheelchairs, and the additional choice of
accessories and repairs to the standard manual and power wheelchairs gives the supplier
the freedom to more accurately report the products and services being rendered.

Comment:
4) The association " ... understands that suppliers must "repair or replace" equipment
they rent ... When the rental payments cap and supplier transfer ownership of the
chair to the beneficiary. the supplier is no longer bound to repair the beneficiary's
wheelchair." The association " ... suggests that CMS clarify how the Agency will
apply the new verbiage to suppliers for beneficiary owned wheelchairs. "

Response:
CMS understands that the wheelchair, at some point, may transfer ownership from
the supplier to the beneficiary due to the rental cap. The added designation of "and
repairs" to the wheelchair categories allows those suppliers who only repair manual
and/or power wheelchairs and/or accessories to be accredited without having to
provide the actual wheelchair. When a supplier checks one or both of these
categories (manual or power) under products and services, accreditation categories
allow for many scenarios of providing the wheelchairs and repairing the
wheelchairs and/or their accessories, without regard to wheelchair ownership.

Comment:
5) "Further, depending on how CMS depends to apply the new language, suppliers
might need to update and resubmit their CMS-855Sforms to ensure their NSC
records are accurate . ... if the suppliers PECOS file does not correspond to the claim
he submits, implemented, the supplier's repair claims could be denied, "

Response:
CMS thanks the commenter for pointing out the importance of correct enrollment
information as it pertains to PECOS and claims reimbursement. However, the
current and revised CMS-855S includes a list of required supplier standards. 42
C.F.R. section 424.57 (c)(6) states a supplier must notify beneficiaries of warranty
coverage and honor all warranties under applicable state law and repair or replace
free of charge Medicare covered items that are under warranty. In addition, 42
C.F.R. section 424.57 (c)(l4) states a supplier must maintain and replace at no
charge or repair directly or through a service contract with another company
Medicare-covered items it has rented to beneficiaries. Medicare beneficiaries also
are informed under the capped rental rule that once a wheelchair is not covered by
the above two standards, they may contact any supplier they wish to repair or
replace wheelchairs and/or accessories, (e.g., a comparison similar to contacting any
plumber they wish for a leaky pipe). As every DMEPOS supplier is required to
revalidate its enrollment information every three years (or sooner if there are
special initiatives being implemented), CMS does not feel the additional language
would require a change of enrollment information be submitted by the supplier
until such a time as the supplier is submitting a change of enrollment information
for another category or the supplier revalidates its enrollment information. At the
time of an additional change of enrollment information or revalidation, the supplier
can then update the products and services, if necessary, as they pertain to
wheelchairs.

Comment:
6) "We also request that CMS clarify whether the agency will direct DMEPOS
accrediting bodies to examine the repair processes ofsuppliers once the new 855S
form goes into effect?''

Response:
The additional products and services breakdown of wheelchair categories was
requested by DMEPOS accrediting bodies. CMS is not planning on directing the
accreditors to examine the repair processes as a result of the revisions in the CMS-

855S. However, the accreditors currently examine the repair processes of suppliers
as part of their accreditation requirements.

Comment:
7) "CMS should also clar(fj; why the Agency did not include similar language under the
Complex Rehab related accessories category. We do not understand the rationale for
treating Complex Rehab related accessories differently from Standard Manual and
Power Wheelchairs related accessories. "

Response:
We received no comments requesting to do so.

Comment:
8) "We have similar concerns and questions about the new language added to the
Support Surfaces designation. The form adds "New'' and "Used" as descriptors in
this category. It is unclear how suppliers apply the support surfaces designation to
their businesses given the addition of this verbiage. We request that CMS clarify how
suppliers should apply this new designation. "

Response:
CMS thanks the commenter for pointing out this additional descriptor. "Support
Surfaces: Pressure Reducing Beds/Mattresses/Overlays/Pads" was revised into two
distinct categories (new and used) because CMS has determined a need to provide a
breakout between new and used to solve a recent issue with competitive bidding. In
competitive bidding, some suppliers only offer new items and therefore do not need
a germicidal license required by some states for used Support Surfaces: Pressure
Reducing Beds/Mattresses/Overlays/Pads. The current CMS-855S does not provide
the distinction between new and used Support Surfaces: Pressure Reducing
Beds/Mattresses/Overlays/Pads and therefore CMS cannot determine the suppliers
who require the germicidal license because they are providing used Support
Surfaces: Pressure Reducing Beds/Mattresses/Overlays/Pads.

Comment:
9) Regarding "Support Surfaces: Pressure Reducing Beds/Mattresses
/Overlays/Pads" "For example, with Medicaid, the delivery ticket has to indicate that
the equipment is new at the time that is first delivered and if not, it has to be picked
up and new equipment delivered when the item reaches the purchase amount. For fee
schedule purposes, New (NU) modifier is defined as the purchase of an item that has

never been used and the Used (UE) modifier is the purchase of an item that has been
previously used. Do the same definitions apply to the 855S, or are the terms applied
differently, such as with Medicaid, since there is no descriptor of Rental (RR) or does
this mean the supplier provides both new and used equipment and there is no
correlation to claims for validation?"
Response:
This revised CMS-855S form does not change any existing definition or the
application of any existing definitions to the form.