CMS delays release of revised CMN

Monday, January 31, 2005

WASHINGTON - CMS started 2005 by breaking a 2004 resolution to issue a revised CMN for power wheelchairs by year’s end.

Despite pressure from the HME industry and its allies on Capitol Hill to complete the work in 2004, CMS announced Dec. 30 that it intends to have the updated document out by mid January, said Seth Johnson, director of government affairs for Pride Mobility Products.

In its effort to clarify or craft new coverage criteria for wheelchairs, CMS apparently has had to put other projects on hold, say industry watchers.

Also delayed until mid January: a revised policy for power operated vehicles (scooters) and a final rule requiring doctors to evaluate patients face-to-face before prescribing a power wheelchair.

The Medicare Prescription Drug Act, which President Bush signed into law in December 2003, mandated the face-to-face evaluation as a way to reduce fraud and unnecessary utilization.

With its POV revision, industry watchers expect CMS to broaden the list of doctors who can prescribe scooters. Currently, that list is limited to neurologists, orthopedist, rheumatologist and doctors of physical medicine.

For more than a year, the current CMN has created confusion among rehab providers. While Medicare’s coverage policy requires that a beneficiary be bed- or chair-confined in order to qualify for a power wheelchair, the CMN simply asks whether the beneficiary needs a power wheelchair to move around the home. By revising the CMN, providers hope CMS eliminates that confusion and eliminates or broadens the definition of bed-or-chair confined.