Industry mounts offensive

Saturday, September 30, 2006

WASHINGTON - With time not on its side, the rehab industry in August scrambled to collect examples of how CMS's new coverage criteria for power mobility devices will create access problems for beneficiaries.
CMS planned to implement its new local coverage determination Oct. 1, but the industry, armed with stories of how the LCD would leave beneficiaries stuck with inadequate power wheelchairs and scooters, hoped to stall the agency.
"All of this has happened rather hastily," said Laura Cohen, co-coordinator of The Clinician Task Force. "We've seen things developed in silos and now that we're seeing how they're going to work together, we're realizing people are going to be left behind."
CMS released 64 new codes for PMDs last year. In August, it released a product classification list, preliminary pricing information and the LCD. CMS was expected to release a fee schedule for the new codes in mid-September. The rehab industry's biggest beef with the new LCD: Its frequent references to downcoding (See story p.1).
The industry hopes the case studies will "put a face" on the issue, making more of an impact, industry sources said.
Additionally, the industry planned to work with legislators to put pressure on CMS, said Simon Margolis, vice president for clinical and professional development at National Seating & Mobility.
"We need to find a couple of members of Congress who will write strong letters and make strong calls to (CMS Administrator Mark McClellan), who will then make calls down the line," said Margolis, who also sits on NCART's executive board.
senators go to bat
Three legislators have sent strongly worded letters to CMS asking the agency not to implement the new codes for power mobility devices Oct. 1. The legislators also ask the agency not to implement the accompanying coverage criteria and the yet-to-be-released pricing.
"Unfortunately, it appears as though we are in the same or similar position as we were last year, regarding new coding, the LCD and the fee schedule being quickly implemented when many are expressing concerns and problems that need to be addressed," stated Sen. Rick Santorum, R-Pa.
The legislators suggest CMS implement the new codes Jan. 1, 2007, for use on claims with dates of service on or after April 1, 2007. The delay would allow the industry to work with CMS to improve the codes, the legislators said. It would also give providers more time to adapt to the changes.
Sen. Arlen Specter, R-Pa., and Rep. Don Sherwood, R-Pa., also wrote letters.