Industry awaits Congressional direction on PWC coverage

Sunday, November 28, 2004

November 29, 2004

WASHINGTON - The industry is eagerly awaiting the passage of Congress’s mammoth appropriations bill, which includes language that confronts CMS on two issues at the center of its efforts to revamp power mobility coverage.

The bill, which was expected to pass before the Thanksgiving break was set aside in a continuing resolution due to a controversial provision on tax return oversight. The bill will be voted on when Congress reconvenes on December 6.

In a section of the omnibus bill addressing Labor/HHS/Education, Congress "strongly encourages" CMS to develop a coverage policy based on the functional standard of nonambulatory, a position that clinicians’ groups have been lobbying for.

"The industry needs some clarity in this benefit, needs to know how to adjust to the changes taking place," said Calvin Cole, Hoveround’s director of corporate development. "And now with coding, pricing and coverage coming, it’s nice to know the congressional intent is to provide this benefit to people who need it."

Similar language addressing functional ambulation was first included in language that was approved by the House Appropriations Committee this summer. Sen. Arlen Spector, R-Pa., included the section in the Senate’s draft of the legislation, adding a section that goes a step further by addressing in-the-home restrictions.

This addition heeds complaints from beneficiary organizations that CMS’s current interpretation of "in the home" is limiting and denies beneficiaries access to medically necessary power mobility devices.

The bill reads: "The Committee would like CMS's views on what steps can be taken to modify this [in the home] rule in a manner that enhances the independence of beneficiaries with disabilities of all ages, while being cost effective and providing for effective safeguards against fraud and abuse."

"This is great language. I couldn’t have written it better myself," said Cara Bachenheimer, Invacare’s vice president of government relations.

Industry insiders say the addition of this section in the bill illustrates Congress’s commitment to the issue of access, and they are confident CMS will act in kind.

"Typically CMS does follow this report language because they know next year when the president releases his budget that they are going to have to go before the Appropriations Committee to justify their amount in the budget," said Seth Johnson, vice president of government affairs at Pride Mobility. "If Congress is not happy with the direction the agency has been moving, they have been known to take that out on them during this funding process."