PMD Rule Delayed Until April

WASHINGTON–A controversial CMS rule that does away with
Medicare’s power mobility certificate of medical necessity and
requires suppliers to keep patient records on file has been put on
hold for a few months.

On New Year’s Eve, President Bush signed into law the Labor-HHS
appropriations bill, which includes a provision that prohibits CMS
from using resources to implement or enforce its interim final rule
for power mobility devices until April 1.

A few days after the IFR took effect Oct. 25, Sen. Arlen
Specter, R-Pa., introduced the amendment in an effort to delay its
implementation.

The measure also instructs CMS to issue a proposed rule by Jan.
1–though that has yet to be published–followed by a final rule to
be issued Feb. 14.

Industry leaders also were relieved that a provision in the
original amendment that would have reduced payments for power
mobility devices by 1.5 percent was removed from the final
version.

“This gives suppliers a bit of breathing room to better educate
physicians about documentation,” said Cara Bachenheimer, vice
president of government relations for Elyria, Ohio-based Invacare
Corp. “But if providers have already made operational plans, they
should continue to do that.”

The IFR caused an uproar among mobility stakeholders following
its release in late August (see HomeCare
Monday, Aug. 29, 2005). Opponents claimed that the new
requirements were confusing and contended that CMS did not provide
enough time to educate parties about the changes and implement
processes to incorporate the new regulations.

Rita Hostak, vice president of government relations for Sunrise
Medical, said she is concerned the delay may cause additional
confusion for some suppliers and physicians, but she added that it
does give CMS the chance to improve upon the rule. “It is critical
for there to be clarity regarding what defines adequate
documentation to support medical need for power mobility equipment.
This should be highly predictable and objective, whether it is
being viewed by a physician, therapist, supplier or someone in
medical review,” Hostak said.

Also, she pointed out, with the various pieces of mobility
guidance that have been published by CMS at different times since
the NCD was released, “the delay provides an opportunity to publish
it all in one well-written regulation.”

Until CMS issues further details on how to handle documentation
for mobility claims, Invacare recommends the following:

–Beneficiaries should continue to have a face-to-face exam with
the prescribing physician, but the 30-day time period between the
date of exam and the date the physician provides the supplier with
a prescription and supporting documentation is suspended. If there
is a longer period of time between these two events, the claim
should not be denied.
–The NCD for mobility assistive equipment still determines the
coverage criteria, and suppliers should use this as a base to
educate physicians about Medicare coverage criteria.
–Suppliers should use the delay period to better educate
prescribing physicians on the coverage criteria (for example,
educate physicians on the nine questions in the NCD).
–If your company is comfortable complying with the requirements of
the IFR issued Aug. 26, 2005, Invacare said, “we do not see any
reason to change your operations. We expect any new rule to be
substantially similar to the one issued in August.”

To view the text of the appropriations bill, also known as H.R.
3010, visit http://thomas.loc.gov.

To view the IFR, click
here.