CMS tackles eligibility guidelines

Wednesday, June 30, 2004

BALTIMORE - CMS is culling physicians, nurses, PT/OTs and rehab experts from among various federal agencies to populate a workgroup that will develop new guidelines for power wheelchair eligibility.
Cara Bachenheimer

Sean Tunis, the CMS chief clinical officer who is heading up the Wheelchair Workgroup, convened the first public listening session on the matter June 14 and expects to issue a draft of the guidelines by october.

“There is going to be a genuine and honest process for getting as much input as we can,” said Tunis. “I can guarantee people that we will understand these issues by the time this process is completed.”

CMS called for the development of the work group in its new three-pronged plan to strengthen its power wheelchair policy. Additionally CMS will develop a new set of codes for power wheelchairs and new quality standards for suppliers.

The industry has been pushing for CMS to be more explicit about who qualifies for a power wheelchair. Until recently, CMS preferred to let physicians make that call. The first prong of the new plan is welcome news for advocates of greater clarity, but the industry objects to CMS’s decision to restrict membership in the work group to federal employees.

If CMS did form an advisory committee of individuals from outside the government, the process would be subject to provisions of the Federal Advisory Committee Act (FACA), which would require the workgroup to inform Congress and the public of their activities.

“There’s the issue of speed and operational burden involved with having non-federal employees on the committee,” said Tunis. “I don’t think the incremental value of [letting non federal employees] have a so-called seat at the table is worth the additional burden.”

The industry is adamant that the development of new guidelines requires the perspective of people who working with powered mobility everyday, if not members of industry than clinicians with reputable rehab facilities.

“While we applaud their need to do this quickly, you can’t sacrifice quality for expediency,” said Cara Bachenheimer, vice president of government relations at Invacare.

She supports the development of an advisory committee that would be subject to FACA.

Tunis said the 10 to 12 members of the workgroup would include clinicians from the Department of Veterans Affairs who are working with users of powered mobility, as well as other experts within the government’s healthcare agencies. But just how expert those folks will be worries Simon Margolis, vice president for clinical and professional development at National Seating and Mobility.

“One of their physicians I’ve heard speak a couple of times at a meeting, she has absolutely no clue,” said Margolis. “No clue at all.”

Tunis said that through public listening sessions, written testimony and “face-to-face meetings” with “relevant interest groups,” he was confident that the workgroup’s panel would gain sufficient input.

“There is no internal expert in this agency on molecular imaging, but we still make very well informed and legitimate evidence-based decisions by having a process where we interact extensively with all of the experts to make sure we understand the issues before we issue policy,” said Tunis.

The industry likes CMS’s step toward the VA but is worried that other forms of input won’t be sufficient.

“It really is incumbent on CMS to do this right this time,” said Margolis. “If CMS does it any other way, they are going to come up with another policy like the one they’ve got.”