DMERCs Release Draft Mobility LCD

BALTIMORE–After months of waiting for additional guidance on
Medicare’s power wheelchair and scooter coverage, the home medical
equipment industry got what it was asking for when the DMERCs
issued their draft LCD on Wednesday. But some stakeholders say
their questions remain unanswered–and that the power mobility
policy changes are too many and coming too fast for the industry to
adjust.

The LCD expands on CMS’ national coverage determination for
mobility assistive equipment, issued May 5. Posted on the DMERC Web
sites, the document addresses medical conditions required for
coverage, proof of medical necessity, coverage of accessories and
phase-out of the power mobility certificate of medical
necessity.

After a comment period that ends Oct. 31, the final LCD is
expected to be released in December, and is set to take effect Jan.
1, 2006, to coincide with new power mobility codes and pricing. The
LCD is identical for all four DMERC regions, but there may be some
discrepancy among the DMERCs in the amount of review, a CMS
official said.

Both HME providers and manufacturers had looked for the draft to
give more guidance about claims documentation and other aspects of
the agency’s new interim final rule, such as the 30-day timeframe
involved for physician prescription of equipment. But the LCD
raises other questions, according to Seth Johnson, director of
government affairs for Exeter, Pa.-based Pride Mobility. “The LCD
did provide some additional information, but certainly these
additional documents [on coding and testing] that were released do
raise significant questions and further support the need for delay
in implementation for power mobility to at least April 1. We know
that the LCD will not be finalized until at least December.

“How can you implement the PMD rule without the LCD being
finalized [and without] additional guidance the industry needs?”
questioned Johnson.

The Region B and D DMERCs will hold a meeting Oct. 11 from 1
p.m. to 3 p.m. at 6375 Castleplace Drive in Indianapolis to get
comments on the draft LCD. To teleconference into the meeting, send
an e-mail to [email protected]
for Region B, and to [email protected]
for Region D.

To view the LCD and submit comments, visit:

www.palmettogba.com/palmetto/palmetto.nsf/(News)/2EB6E2A61F1255568525707C0074CE62?OpenDocument.

For information on the NCD, which replaces “bed or
chair-confined” language with a functional approach to prescription
of power mobility equipment for Medicare beneficiaries, see

HomeCare Monday, May 9.