Health Law Daily Wrap Up, DURABLE MEDICAL EQUIPMENT—DAB DECISIONS: CMS properly determined effective date of enrollment of Medicare durable medical equipment supplier, (May 27, 2026)

By Sara Cracau, J.D.

DAB upheld CMS’ determination that the effective date of enrollment of supplier of DMEPOS was September 9, 2024.

The HHS Departmental Appeals Board (DAB) has upheld the decision of the CMS that determined that the effective date of Medicare enrollment of a Medicare supplier of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for all its locations to be September 9, 2024. The applicable regulations provide that a supplier is eligible to receive payment for Medicare-covered items only after it has submitted completed applications and been issued a supplier number by CMS. The DAB noted that because the supplier’s applications were not complete as of January 1, 2024, the effective date which the supplier requested , the supplier did not demonstrate that it was entitled to Medicare enrollment on January 1, 2024. According to the relevant statutory and regulatory authorities, CMS was permitted to assign effective dates as September 9, 2024 (Access PT Pennsylvania v. CMS, DAB No. CR6768, Doc. No. C-25-432, September 3, 2025).

Background. A supplier of DMEPOS submitted internet-based applications to enroll in the Medicare program for three of its locations, requesting January 1, 2024 as an effective date. On July 31, 2024, the Medicare administrative contractor sent requests to the supplier to further develop its applications and provide specified information for each of its locations and notified the supplier that unannounced site visits would occur at each location. The requested information included: a valid legal business name as the name on the application did not match the legal business name shown in the IRS document; copies of all applicable contracts that the supplier had with other companies to purchase items needed to fill orders; a valid certificate of liability insurance; and a title that reflects the authority of C.A. to serve as an authorized official in the ownership interest/managing control individuals section. Site visits then occurred on August 7 and 12, 2024. In response to the request, the supplier provided its responses with final corrections on September 3, 2024. The Medicare contractor approved the enrollment applications with an effective date of September 9, 2024 for each of the supplier’s locations. The supplier requested reconsideration requests seeking effective dates of January 1, 2024 but the previous determination was upheld. The supplier timely filed hearing requests for its three locations. CMS filed for summary judgment.

Analysis. According to the relevant statutory and regulatory authorities, CMS was permitted to assign the effective dates as September 9, 2024. because the supplier’s applications were not complete as of January 1, 2024, the effective date which the supplier requested , the supplier did not demonstrate that it was entitled to Medicare enrollment on January 1, 2024. CMS contended that a supplier cannot be given an effective date that is earlier then the date which CMS administrative contractor determines that the supplier meets all the enrollment requirements, a site has been conducted, and a supplier number has been issued. The DAB found that the applications the supplier submitted on December 4, 2024 were incomplete. The application required the following corrections: it had to provide a title reflecting the authority to serve as an authorized official in the ownership interest/managing control individual section for C.A., an individual listed in the supplier’s application. Regulations require that an application for billing practices be signed by an individual whose signature binds the supplier. Because the December 4, 2023 applications did not include a signature, the application was not complete. Absent a specific, regulatory requirement that CMS determine each requirement is met, the payment provisions could be interpreted to require CMS to issue a supplier number effective the date the application is submitted, provided that a site visit has been completed. In this case, the date would have been September 3, 2024. Because the relevant conditions were not met on January 3, 2024, the DAB lacked authority to grant the supplier’s request of an earlier effective date of enrollment.

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