CMS Gives DMERCs Go-Ahead on New Mobility Policy

BALTIMORE–On Friday, CMS sent formal instruction to the durable
medical equipment regional carriers to implement Medicare’s new
mobility coverage policy, paving the way for the four DMERCs to
issue interim guidance for equipment providers and work on local
medical review policy.

In its Change Request, the agency told the DMERCs to disregard
the “bed- or chair-confined” criterion–historically used to
determine medical necessity–and instead use the functional
approach outlined in the National Coverage Determination released
May 5, which bases coverage on a beneficiary’s ability to perform
activities of daily living.

The new policy is effective for mobility claims with dates of
service from May 5 forward, according to the CMS instruction, which
adds that the DMERCs “may adjust claims back to May 5, 2005, if
brought to their attention.”

This means that if a provider brings up a claim–with a date of
service on or after May 5–that was denied under the old bed- or
chair-confined language, the DMERCs “are required to review the
case under the new policy,” a CMS spokesperson told HomeCare
Monday. The spokesperson added that providers should contact
their carrier “to find out how the DMERC wants [the claim]
resubmitted under the new coverage standard.”

According to Dr. Robert Hoover, medical director for Region D,
the DMERCs plan to post a “transition article” on their Web sites
to serve as interim guidance while they draft the LMRP.

What’s lacking is documentation guidance, said Cara
Bachenheimer, vice president of government relations for Elyria,
Ohio-based Invacare Corp. She said the Restore Access to Mobility
Partnership–a coalition that includes the American Association for
Homecare, Invacare, The Med Group, Mobility Products Unlimited,
Pride Mobility and Sunrise Medical–“has been pressing CMS and the
DMERCs to issue detailed documentation requirements. We don’t yet
have a response on exactly what direction CMS may be going.”

The new coverage policy is part of a larger effort to revamp
Medicare’s mobility benefit. Earlier this year, CMS introduced 49
new power chair and scooter codes that will take effect Jan. 1. The
agency is also working through a regulation requiring a
face-to-face physician exam for the equipment, a revision of the
POV policy and is considering a new wheelchair CMN.