Industry Leaders Ask CMS to Clarify Mobility NCD

WASHINGTON–Industry leaders are pushing CMS to clarify
Medicare’s newly released mobility coverage policy.

The Restore Access to Mobility Partnership has asked CMS to
issue interim guidance on the National Coverage Determination as
soon as possible so HME stakeholders “can eliminate the possibility
that severe problems could result from the new coverage policy
during the transitional period before companion regulations are
released.

“CMS’ intentions are unclear with respect to the impact of
mobility limitation on completing the activities of daily living,”
according to a statement from RAMP, a coalition that includes
AAHomecare, Invacare Corp., The Med Group, Mobility Products
Unlimited, Pride Mobility and Sunrise Medical.

The National Coalition for Assistive and Rehab Technology also
said there are numerous areas of the NCD that are “vague and open
to interpretation.”

In a recent statement, NCART said that “CMS will allow coverage
of [mobility-assistive equipment] where a caregiver is compensatory
‘if consistently available in the beneficiary’s home….’ There are
multiple problems with these criteria, particularly for prescribing
wheelchairs. What is meant by ‘consistent’? Who determines
consistency? What sort of recordkeeping will be required? Moreover,
who determines when a beneficiary is noncompliant with treatment
and therefore does not qualify for MAE?”

The new mobility coverage policy, released May 5, eliminates the
requirement that Medicare beneficiaries be bed- or chair-confined
and instead adopts function-based criteria for determining medical
necessity. However, the policy kept in place the in-the-home
requirement, language that RAMP, NCART and other advocacy
organizations are seeking to eliminate.

The organizations are also pushing to expand the definition of
“activities of daily living”–which the government defines as
activities such as eating, grooming, bathing and toileting–to
include mobility itself.

To read the NCD, click
here.