Beneficiary Rights and Protections Regarding Durable Medical Equipment (DME)

One of the positive side-effects of the DMEPOS (durable medical equipment, prosthetics, orthotics and supplies) Competitive Bidding Program is that the Centers for Medicare & Medicaid Services (CMS) is using it as an opportunity to broadcast the message to ALL beneficiaries who use DME, no matter where they live, or no matter what equipment or supplies they use, that beneficiaries have clear-cut protections and rights concerning how they are to be supplied, treated, educated, supported, and kept safe regarding any piece of equipment, orthotic, prosthetic or supply Medicare covers and which is provided by a Medicare supplier.

More specifically, beneficiary protections and safeguards involving equipment and supplies include:

1. Beneficiaries must be treated with respect and their privacy assured.

2. Beneficiaries must be given suitable information about the set-up, safe and correct use, troubleshooting, cleaning and maintenance of their equipment.

3. Beneficiaries must be provided this information in accord with their abilities, learning preferences and language.

4. Beneficiaries must be instructed in effective infection control techniques appropriate to their equipment and supplies; this is critical for the health of the beneficiary.

5. Beneficiaries must be given, when needed, appropriate, knowledgeable, and professional assistance (including a home visit, if required) by the supplier, for example, if the equipment does not appear to be working properly, or having the desired result, or the beneficiary needs additional guidance in operating the equipment, or whenever it needs repair or maintenance.

6. Beneficiaries must be given a customer service phone number which is available both during and after regular business hours.

In addition, for certain types of equipment, such as respiratory equipment, power mobility devices (such as power wheelchairs), complex rehabilitative wheelchairs and assistive technology, additional safeguards and standards are in place.

For a more detailed statement of these rights and protections, go to www.cms.gov, search for “Supplier Quality Standards and Beneficiary Protections,” and click on the March 2013 document.

If the beneficiary believes, after contacting the suppler, that the supplier is not reasonable supportive of their rights and protections as enumerated above, they should call 1-800-Medicare and complain. Alternatively, beneficiaries may call their State Health Insurance Counseling Program (or SHIP, their number is on the back of the Medicare & You booklet) and ask for assistance. It may be that the SHIP will have to ask for a CMS Regional Office to intervene.