Industry comments on proposed PWC criteria

Sunday, March 6, 2005

March 7, 2005

WASHINGTON -  There was no shortage of comments for CMS at the Feb. 24 open door forum on the proposed power wheelchair national coverage policy. Industry representatives, clinicians and beneficiaries crowded the phone lines, with comments centering on three distinct issues: the in-the-home restriction, documentation requirements and the definition of activities of daily living.
The three-hour meeting held at CMS headquarters gave stakeholders the opportunity to air their concerns about the proposed coverage policy that was unveiled Feb. 3. The deadline for written commentsis March 7, and a final coverage policy is expected to be released by the end of March.
Clinician Task Force members and consumers championed the need for CMS to revise the in-the-home requirement for coverage during the meeting. While the proposed NCD eliminates the contentious bed-or-chair confined requirement, CMS maintains that it can’t drop the in-the-home restriction, which says that equipment can only be covered if it is needed for use inside the home.
That notion was challenged throughout the meeting, according to a RAMP statement. Many people urged CMS to use its administrative power to reinterpret the rule.
“I don’t think there is a legal impediment to getting past this in the home limitation,” said Jim Sheldon, of Neighborhood Legal Services of Buffalo and the National Assistive Technology Advocacy Project. “I’m going to suggest it is really a political, rather than a legal barrier that the agency is facing.”
“Our primary concern is that it colors or affects the entire process,” added Task Force member Dr. David Wysocki. “We believe it makes it difficult to actually have a fully functional based criteria.”
For mobility providers, concern over what documentation would be required to substantiate medical necessity was at the forefront of the meeting.
“We just need a clear and consistent standard in order for the coverage policy to appropriately be implemented, so we are not working under an ambiguous documentation standard as we are now,” said Seth Johnson, vice president of government relations at Pride Mobility Products.
The proposed NCD does not spell out any specific on documentation. Johnson said Medicare plans to rely heavily on public comments to craft the policy.
“CMS is not going to be releasing a new CMN until after the comment deadline,” he said.  “They want to use those comments to see what changes need to be made to the CMN or if someone suggests something better than the CMN that would be more effective tool in proving medical necessity,” he said.
Johnson said he expects Medicare to issue a new CMN at the beginning of April.