DMERCs Issue 'Bridge' LCD
DMERCs Issue 'Bridge' LCD ATLANTA--The DMERCs issued revised draft local coverage determinations for mobility devices on Tuesday, bringing current codes into step with CMS' national coverage determination issued in May.
The LCD was originally scheduled to be implemented Jan. 1, 2006, but will be delayed to take effect at the same time as the agency's new power mobility codes, CMS announced on Oct. 14 (see HomeCare Monday, Oct. 17).
While there is no definite timeframe associated with the delay, SADMERC Medical Director Dr. Doran Edwards told Medtrade attendees last week that he anticipates the new PMD codes could possibly be ready by sometime in mid-2006. According to Edwards, "The length of time for wheelchair manufacturers to do the test we require, whatever that turns out to be, will drive when the codes become effective."
A CMS technical advisory panel on the codes (see story above) has three interim deadlines for completing its work, according to Edwards. The first--April 1, 2006--is "not going to happen," he said, and a July 1 date is "iffy but possibly doable." But a target of October 1 "has real potential."
In the meantime, the revised LCD will function as a bridge policy for continued use of the current codes--K0010, K0011, K0012, K0014 and E1230--based on the NCD until the new codes become effective. As providers have been requesting since the NCD was issued May 5, the revision includes claims documentation guidance based on CMS' new algorithmic approach to coverage of mobility assist equipment.
Edwards noted, however, that the existing LCD still has an open comment period. "Even though it is now withdrawn," he pointed out, "that policy will very likely be the one that [CMS] will go back and use as the template to tie to the new codes whenever we finish those, so your comments are important."
He urged all stakeholders to "go ahead and turn your comments in before the deadline."
To view the revised LCD, visit www.tricenturion.com.
Interim Final Rule Takes Effect Tomorrow While most industry-watchers viewed the revised LCD and power code delays as good news, some pointed out that CMS' interim final rule on power mobility is still scheduled to take effect Oct. 25 (tomorrow) as planned--unless an effort by the Power Mobility Coalition to delay its implementation is successful.
The organization filed suit against the government Oct. 13 and is asking for a preliminary injunction that would delay the rule, which eliminates the certificate of medical necessity for Medicare reimbursement of power wheelchairs and scooters.
According to the PMC, the rule "would decrease beneficiary access to PMDs, increase the regulatory burdens placed upon physicians and irreparably harm suppliers of PMDs." The rule also includes a requirement that physicians or other treating practitioners conduct a face-to-face examination of patients when prescribing PMDs, and expands the types of physicians and practitioners who may prescribe power operated vehicles or scooters. (See HomeCare Monday, Aug. 29.)
"Since the rule is scheduled to take effect a full month before comments are due, it is difficult to believe that CMS could consider public comment and modify the rule at a later date," stated PMC Director Eric Sokol.
A court hearing on the matter is scheduled tomorrow.