Senators Request Delay, Changes to CMS Power Mobility Policies

WASHINGTON–CMS’ latest power mobility changes have caught the
attention of three U.S. senators, who are urging the agency to
rethink its new policies and its timeline for implementation.

In a letter to HHS Secretary Michael Leavitt and CMS
Administrator Mark McClellan, Iowa Sen. Charles Grassley said parts
of the power mobility interim final rule, released Aug. 24, “appear
to be overly restrictive, confusing and impossible to successfully
implement in the proposed time frame–fueling fraud, waste and
abuse in the Medicare program.”

At the same time, Pennsylvania Sens. Rick Santorum and Arlen
Specter are pushing for a delay in implementation of the rule and
63 new power mobility codes released in September.

While the interim final rule eliminates the CMN for power
mobility devices, requiring providers to submit only a physician’s
prescription for Medicare reimbursement, it requires providers to
gather patient records from physicians that document medical
necessity and supply them upon request. (See HomeCare
Monday, Aug. 29.)

“In the sprint to publish these requirements, CMS may have added
an unnecessary degree of subjectivity to this process,” Grassley
wrote in his Sept. 29 letter. Elimination of the CMN may open the
door to “fraud, confusion and subjectivity,” he said.

“At the very least,” Grassley continued, CMS must “clarify its
[national coverage determination]” and “provide additional
guidance” on its provisions. He added that CMS should consider
working with contractors to ensure consistency throughout the four
DMERCs as they work to develop their local coverage
determinations.

Grassley, chairman of the powerful Senate Finance Committee,
which oversees Medicare, urged CMS to reconsider the Oct. 25
implementation date for the interim final rule. “It seems as if CMS
is trying to finish a puzzle with some essential pieces missing,”
he said.

He also asked how competitive bidding and supplier quality
standards would affect the PMD benefit, and requested a response
from McClellan by Oct. 11.

In a separate letter to McClellan, also dated Sept. 29, Santorum
and Specter proposed delaying implementation of the new PMD codes
until July 1, 2006, and delaying the interim final rule until April
1. “The absence of a reasonable period for advance preparation to
the change in rules may overwhelm PMD providers and manufacturers
striving to comply and remain commercially viable,” the senators
wrote.

Last month, CMS released 63 new power mobility codes–replacing
the 49 that were issued in February–along with revised product
testing requirements. They are scheduled to take effect Jan. 1.
(See HomeCare
Monday, Sept. 19.)

A delay would allow more time to educate physicians, clinicians
and providers about the new rule; make sure all questions are
answered and resolved prior to implementation; and give DMERCs and
outside vendors time for their systems to accept the changes, the
senators said. Delaying the code changes would also give
manufacturers time to adjust and retest products according to the
new standards.