CMS plans to retract PWC clarification

Sunday, March 21, 2004

March 22, 2004

WASHINGTON - CMS plans to order the DMERCs to retract the now infamous Dec. 9 “clarification” that limited eligibility for power wheelchairs to bed- or chair-bound beneficiaries.
“We’re having (the DMERCs) take the article off their Web sites because it has created confusion rather than clarification,” said a CMS spokesperson. “We will be issuing a press release very soon that will set out more detail.”
By retracting the clarification, CMS stated in a March 19 notification to congressional members that it “will continue to pay claims as it has prior to and following the issuance of the December 9, 2003 DMERC Article.”
While the CMS notification is ambiguous, it does appear to give a nod to industry concerns that the clarification is overly restrictive.
Before the DMERCs issued the clarification, many providers and manufacturers understood power chair coverage criteria to rest primarily on whether or not a beneficiary needed a chair to ambulate safely throughout his home. Medicare officials viewed the clarification and intensified scrutiny of supporting documentation as a way to rein in skyrocketing utilization. Industry officials claimed it was actually a policy change and thus required a public comment period, which CMS did not provide, said industry watchers.
“This hit the heart and soul of our business,” said Pride Mobility President Dan Meuser. “It denied access to those with disabilities and because of that we were never going to stop endeavoring to correct this irrational policy, and I think (CMS) saw that.”
By lobbying members of the U.S. House and Senate, the industry apparently generated enough political pressure to force CMS to order the retraction. In all, 10 members of Congress wrote HHS Secretary Tommy Thompson, expressing concern that the “clarification” might be an overly restrictive policy change that denied access to eligible beneficiaries, said Seth Johnson, AAhomecare’s director of public policy.
“Tommy Thompson was coming under tremendous pressure,” added Darren Jernigan, Permobil’s director of public affairs. “In an election year, you’re not going to vote for the man who took away you’re wheelchair."
Lawmakers who voiced concern included Sen. Charles Grassley, R-Iowa, and Democratic presidential nominee Sen. John Kerry, D-Mass.
The Dec. 9 clarification spooked many providers, who in turn refused to furnish powers chair to beneficiaries who didn’t meet the strict chair- or bed-bound requirement,” said Cara Bachenheimer, Invacare’s vice president of government relations.
“Providers were playing by the new rules,” she said. “Some consumers were our of luck, and others were hassled to death trying to find a provider who was brave enough to take their business and submit the claim.”
As CMS moves forward in refining its coverage criteria for power wheelchairs, the industry hopes to lend its expertise to the formulation of policy that determines who qualifies for a power wheelchair. It also must state what documentation above and beyond the CMN is required from providers to support medical necessity, Bachenheimer said.
“We are looking for some predictability in the process,” said Eric Sokol, director of the Power Mobility Coalition. “We can’t have a benefit where every claim is a spin of the roulette wheel as to whether you are going to get paid or not.”