Specifying Brands or Manufacturers of DME

10.12.2 – Specifying Brands or Manufacturers of DME (Rev. 120, Issued: 01-16-15, Effective: 01-01-15, Implementation: 01-01-15) MA plans may specify brands and manufacturers as preferred and charge lower cost- sharing for the preferred brands or may limit the DME to only those preferred brands and manufacturers, as long as the following conditions are met (42 CFR 422.100(l)): • The MA plan provides all categories of DME covered under original Medicare Part B; • The MA plan ensures that enrollees have access to all medically necessary (including non-preferred) DME products or brands; • The MA plan’s contracted suppliers provide access to all preferred DME brands; • During an enrollee’s first year of enrollment in an MA plan, if the enrollee requests, the plan will provide a 90-day transition period (commencing with the initial time of enrollment) during which the plan provides (and repairs, as applicable) non-preferred DME brands furnished in the previous year; • Although the MA plan may add brands to its preferred formulary during the year, it may not remove any brands mid-year; • The MA plan treats denials of non-preferred DME products or brands as organization determinations; • The MA plan discloses DME coverage limitations and appeal rights in the case of a denial of a non-preferred DME product or brand with the EOC and ANOC and on its website; and • The MA plan provides full coverage, without limitation on brand and manufacturer, to DME categories or subcategories annually determined by CMS to require full coverage.