In the last few months, CMS has announced enormous changes that will affect every beneficiary who needs power wheelchairs and scooters/power operated vehicles, collectively known as power mobility devices. Not only will these changes affect every beneficiary with mobility needs, but they also will have a major impact on suppliers, prescribing physicians, other clinicians and manufacturers.
Unfortunately, most of these policies are ill-conceived and have been issued in piecemeal fashion. CMS intends to implement some of these changes at different times, prior to the close of comment periods and prior to stakeholders being able to fully understand and adjust to the changes. The combined impact would result in seniors and people with disabilities having significantly reduced access to the most medically appropriate equipment.
Every supplier who provides wheelchairs should be seriously concerned about the effects of these changes.
Documentation Issues
The interim final rule on face-to-face examinations for PMDs, issued by CMS in August, eliminates the certificate of medical necessity and instead requires physicians to provide suppliers with copies of medical records that are to contain information related to medical need.
At the same time, CMS refuses to provide any meaningful definition of what is appropriate documentation, resulting in a situation where no supplier can provide a mobility device with any confidence that medical need is adequately documented. CMS has not conducted any real physician education about these changes, nor will it be feasible for CMS to do so before the Oct. 25 effective date for the new documentation requirements. This rule has a comment deadline of Nov. 25.
Draft Local Coverage Determinations
Last month, the DMERCs issued draft regional policies designed to provide additional information for prescribing physicians and suppliers on CMS' new national coverage criteria, which was released in May. While the draft local policy did answer some questions related to documentation, it raised many others and left still others unresolved. Under these draft regional policies — and in the national coverage criteria — Medicare will pay for a wheelchair that is functional primarily in the beneficiary's home but not outside their homes, truly imprisoning them.
According to CMS, these draft regional policies will not be finalized until December at the earliest. Comments, which can be e-mailed to the DMERCS, are due Oct. 31.
New Codes
In February, CMS issued a new set of 49 codes for PMDs, including new testing requirements that were to replace the current codes. Manufacturers were required to test their products and submit applications for the new codes by Sept. 1. But on Sept. 14, CMS announced an entirely different set of 63 codes to replace the 49 issued earlier this year, and also announced new testing requirements. CMS is planning on crosswalking to the 63-code system products that had already received code decisions under the 49-code system. Manufacturers do not believe it is possible to crosswalk, simply because the criteria and testing requirements are fundamentally different. Late this year, CMS will issue new allowables for the new codes.
What can you do? First, make sure you understand the various proposed and final policies. Second, submit comments to the DMERCs and CMS on the various polices.
Third, write your senators and representatives for their support in asking CMS to delay implementation of all PMD policies until the many problems are fixed, and there is a rational implementation plan with sufficient advance notice to all stakeholders. Ask them to tell CMS that it needs to immediately announce that all these related changes — face-to-face examination requirement, documentation rules, coverage policies, coding and pricing — cannot be implemented until at least 90 days after all PMD policies and codes are finalized.
There is no time to delay; our mobility industry's future is at stake.
A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at cbachenheimer@invacare.com.
