BALTIMORE--After months of waiting for additional guidance on Medicare's power wheelchair and scooter coverage, the home medical equipment industry got what it was asking for when the DMERCs issued their draft LCD on Wednesday. But some stakeholders say their questions remain unanswered--and that the power mobility policy changes are too many and coming too fast for the industry to adjust.
The LCD expands on CMS' national coverage determination for mobility assistive equipment, issued May 5. Posted on the DMERC Web sites, the document addresses medical conditions required for coverage, proof of medical necessity, coverage of accessories and phase-out of the power mobility certificate of medical necessity.
After a comment period that ends Oct. 31, the final LCD is expected to be released in December, and is set to take effect Jan. 1, 2006, to coincide with new power mobility codes and pricing. The LCD is identical for all four DMERC regions, but there may be some discrepancy among the DMERCs in the amount of review, a CMS official said.
Both HME providers and manufacturers had looked for the draft to give more guidance about claims documentation and other aspects of the agency's new interim final rule, such as the 30-day timeframe involved for physician prescription of equipment. But the LCD raises other questions, according to Seth Johnson, director of government affairs for Exeter, Pa.-based Pride Mobility. "The LCD did provide some additional information, but certainly these additional documents [on coding and testing] that were released do raise significant questions and further support the need for delay in implementation for power mobility to at least April 1. We know that the LCD will not be finalized until at least December.
"How can you implement the PMD rule without the LCD being finalized [and without] additional guidance the industry needs?" questioned Johnson.
The Region B and D DMERCs will hold a meeting Oct. 11 from 1 p.m. to 3 p.m. at 6375 Castleplace Drive in Indianapolis to get comments on the draft LCD. To teleconference into the meeting, send an e-mail to draft.dmerc.lcd.comments@anthem.com for Region B, and to Mary.Rheinecker@CIGNA.com for Region D.
To view the LCD and submit comments, visit:
www.palmettogba.com/palmetto/palmetto.nsf/(News)/2EB6E2A61F1255568525707C0074CE62?OpenDocument.
For information on the NCD, which replaces "bed or chair-confined" language with a functional approach to prescription of power mobility equipment for Medicare beneficiaries, see HomeCare Monday, May 9.