Industry Stakeholders Fight DMERC Power Wheelchair Clarification

Washington

In response to the policy clarification on power wheelchairs issued in December by the four DMERCs, industry stakeholders continue their opposition and have requested an open dialog with the Baltimore-based Centers for Medicare and Medicaid Services on the issue.

According to the DMERCs’ new clarification, power wheelchairs will be covered only for “patients who are non-ambulatory.” (See “The Scooter Store Lays Off 200,” page 8.) Industry advocates have also said that the clarification’s medical review guidelines may be applied retroactively.

“The application of these new policies to beneficiaries who have already received power wheelchairs that met the previously accepted coverage criterion will cause irreparable harm to both beneficiaries and suppliers,” said American Association for Homecare President and CEO Kay Cox. In a December letter to CMS, the association pointed out that no draft was released prior to the DMERCs’ postings, and no effort was made to formally solicit industry or provider feedback.

Meanwhile, the D.C.-based Power Mobility Coalition has requested a meeting with CMS to discuss the definition of “non-ambulatory” and the additional documentation requests from the DMERCs to evaluate claims coverage. According to the PMC, the clarification could severely limit beneficiary access to power wheelchairs and power-operated vehicles. “The new [local medical review policies] completely change the definition of what is meant by ‘non-ambulatory,’” stated PMC Director Eric Sokol in a letter to Angela Brice-Smith, deputy director of the Survey and Certification Group at CMS.

The industry coalition also argued that CMS should have followed its current policies and rules. “Chapter 13 of the Medicare Program Integrity Manual requires that before LMRPs are issued that draft policies are published for public and industry comment,” the PMC said. “If we cannot meet with you immediately to try to address this critical situation, the PMC may be left with no other alternative but to use all available legal and public affairs resources to prevent these policies from devastating the lives of thousands of disabled beneficiaries.”

Meanwhile, Dr. Robert Hoover, the DMERC Region D medical director, said the clarification provides guidance so that each may follow consistent guidelines for power wheelchair coverage. “Region D [DMERC] has been following [the clarification] consistently for quite awhile,” he said. “We’re to apply the national policy as it is written, and the national policy has been [in existence] for a number of years.”

For more on the power wheelchair clarification, see “Washington Wit & Wisdom” on page 60 and “Billing & Reimbursement” on page 62.

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