PSCs Delay Power Mobility Codes, LCD

BALTIMORE–The DME Program Safeguard Contractors said Wednesday
they would delay implementation of the new power mobility codes and
Local Coverage Determination until Nov. 15.

The announcement came at the same time the PSCs released a
“clarified” LCD. The document does not address all of the
industry’s concerns, but it does eliminate the “least costly
alternative” determination that would have resulted in automatic
downcoding to a Group I power wheelchair for patients not meeting
coverage for a Group II or higher chair.

Stakeholders had argued that such downcoding would restrict
Medicare beneficiaries to inexpensive, low-powered models that
could prevent some from getting the equipment appropriate to meet
their needs. But in issuing the revised policy, CMS said it “allows
for greater flexibility to ensure beneficiaries are in the right
chairs for their medical condition.”

“The LCD revisions went a long way to address the industry’s
concerns,” said Seth Johnson, vice president, government affairs,
for Exeter, Pa.-based Pride Mobility and chairman of AAHomecare’s
Rehab Council, who added that he was pleased with the extension of
the transition period. “As far as whether that’s going to be enough
time or not, it’s really too early to tell because we don’t have
the fee schedule information yet.”

The 64 new PMD codes, pricing and LCD originally were scheduled
to take effect Oct. 1, which many industry stakeholders and some
members of Congress argued was too soon. On Aug. 30, Sen. Rick
Santorum, R-Pa., wrote to CMS asking for a delay of the Oct. 1
implementation date.

According to CMS, fee schedules for the new codes “should be
available in the near future.”

Rita Hostak, vice president of government relations for
Longmont, Colo.-based Sunrise Medical and president of the National
Coalition for Rehab and Assistive Technology, also said the
implementation delay and elimination of automatic downcoding were
positive steps, but added she has other issues with the LCD.

“We still have significant concerns [about] the language
regarding an individual’s ability to perform an independent
stand-pivot transfer. This coverage criterion will deny individuals
with disabilities access to equipment that will be functional and
meet their needs,” said Hostak, noting that “we must make every
effort to ensure that the adverse restrictions in this policy are
eliminated.” (See NCART Video Scores with House Ways and Means
Committee.)

Many in the rehab community are concerned that the
interpretation of “independent transfer” could include people who
face a severe struggle to transfer themselves without
assistance.

“When you have claims reviewers looking at these claims, it’s
going to come back to what their definition is of ‘independently,’”
Johnson said. “The rehab community would really like some further
communication as to what an independent transfer is.”

Don Clayback, senior vice president of networks for The Med
Group, Lubbock, Texas, called the revised LCD “a step in the right
direction, but there are still some significant issues for
customers with more complex disabilities.”

In addition to the stand-to-pivot transfer issue, Clayback said
providers need further clarification on coverage of complex
equipment–specifically Group III or higher–so they know without a
doubt that a patient qualifies.

“Providers need the assurance that they’re going to get paid so
that access is not a problem,” he said, recommending that officials
either modify the policy or expand the Advance Determination of
Medicare Coverage so providers know upfront whether they will be
reimbursed for a claim.

The revised LCD is available at http://www.tricenturion.com.