Clinicians bristle over ‘homebounds’ absence in NCD

Monday, February 28, 2005

WASHINGTON - Industry stakeholders were cheered in February by a National Coverage Determination that moved power mobility toward a function-based determination of medical necessity. The contentious “in-the-home” restriction, however, remained a problem for many groups, who lambasted CMS for seemingly ignoring the opportunity to revise the statement.

“Basically it is not possible to write a functional mobility policy if you do not extend ambulation beyond the confines of the home,” said Dr. Laura Cohen, co-coordinator of the Clinician Task Force. “The ability to move from place A to place B is functional mobility and should be considered a mobility related activity of a daily living.”

The Clinician Task Force, along with the Power Mobility Coalition, NCART, ITEM and other mobility groups, has encouraged CMS to change its homebound criteria, which only covers DME if it is needed for use inside the home. Sean Tunis, CMS’s chief medical officer, has said that the coverage process is not the place to revise that policy. Language in the NCD restated this belief.

“Even in the Interagency Wheelchair Work Group report they indicate that they want to extend the benefit beyond the four walls of the home, but in the policy they don’t address that,” said Cohen. “They say that the NCD would not be an appropriate mechanism to change the rule, and they do not provide any explanation or comment as to how they plan to address the issue. It is time to hold CMS accountable - they need to explain what they plan to do.”

The industry is looking for Medicare to cover mobility items beneficiaries who need them to go the bank or to a doctor’s appointment. Advocates say those activities should be considered as instrumental in independent daily living as moving between the bedroom, bathroom ad kitchen.