RAMP Calls for Additional Changes to Power Mobility LCD

WASHINGTON–In a statement issued Friday, the Restore Access to
Mobility Partnership applauded CMS for working with stakeholders to
clarify some issues in the newly revised Local Coverage
Determination for power mobility devices. However, the coalition of
power mobility manufacturers and suppliers reiterated industry
concerns that additional policy revisions and pricing information
are still needed.

Last month, the DME Program Safeguard Contractors issued the
revised LCD, eliminating the “least costly alternative”
determination, or automatic downcoding, that had drawn fire from
both patient advocates and equipment manufacturers (see HomeCare Monday, Sept. 25).

While RAMP said it appreciates the change, it is requesting
additional assurances from CMS that downcoding will not occur. “At
this point, stakeholders are merely seeking a letter or some kind
of other written confirmation that this will be the policy so that
it won’t ever be an issue in the future when claims are under
appeal or under review,” the organization said.

RAMP also said CMS should eliminate the stand-and-pivot
criterion used to determine whether a Medicare beneficiary
qualifies for a Group 3 power wheelchair. Only patients who are
incapable of an “independent transfer” qualify for a Group 3 chair,
but some stakeholders are concerned that a literal interpretation
of “independent” could include people who face a severe struggle to
transfer themselves.

This requirement should be replaced with clinical criteria that
will provide access to the proper medical equipment for patients
requiring complex rehabilitation, RAMP said.

Moreover, RAMP said that more should be done to address the
future medical needs of patients with progressive and degenerative
conditions. “But CMS is currently saying that their future needs
should be addressed through the review and appeals process, which
in many cases may delay patients from receiving the proper power
wheelchair–when they need it,” the statement read.

The issue could be resolved if CMS added language to the LCD
providing coverage of Group 3 wheelchairs or higher to
beneficiaries living with progressive and degenerative conditions,
RAMP said.

The organization also stressed the need for pricing information,
because “if the fee schedule is too low for certain power
wheelchairs and scooters, suppliers and manufacturers won’t be able
to provide the equipment.”