CMS prepares to release new coverage criteria for PWCs

Sunday, March 27, 2005

March 28, 2005

BALTIMORE - CMS expects to release a slew of regulations and policies Tuesday, March 29, that affect how Medicare pays for standard and power wheelchairs. In addition to new coverage criteria, industry watchers expect CMS to issue a revised CMN for wheelchairs; a final or interim rule on Medicare’s new face-to-face requirement; and a revised rule on who can prescribe scooters.
CMS planned to issue the new policy and documents Friday, but delayed those plans because a key official who needed to sign off on them was out of town, said Seth Johnson, Pride Mobility Product’s director of government affairs.
For more than a year, the current CMN and coverage criteria have 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.
While the new coverage criteria will be final, CMS will take public comment on the revised CMN for 30 days and possibly longer.
In crafting its new coverage criteria, CMS has replaced the bed-or-chair-confined criteria with a standard based on a beneficiary’s ability to perform mobility related activities of daily living. Those activities include, but are not limited to, eating, bathing, grooming, toileting and feeding, Johnson said.
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. The law didn’t, however, spell out particulars about the new requirement. The final or interim final rule will do that.
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, orthopedists, rheumatologists and doctors of physical medicine.