LCD for power chairs contains major flaws, industry says

Sunday, August 20, 2006

WASHINGTON - The new coverage criteria for power mobility devices could put beneficiaries with serious needs into wheelchairs and scooters that aren't meant for regular use, the rehab industry fears.

"We're more than disappointed," said Cara Bachenheimer, vice president of government relations for Invacare. "This is such a downgrading of the type of product that Medicare will cover for beneficiaries with real mobility issues, that there will absolutely be direct consumer impact."

The 38-page coverage criteria, released last week, stresses downcoding and "least costly alternative determination." That, coupled with the way the new power mobility codes are structured, means a beneficiary with early-stage ALS, for example, qualifies only for a wheelchair in the first--and least complex--group of codes, industry sources said.

The impact of the LCD on beneficiaries could be far-reaching. Industry sources estimate that, under the new coverage criteria, up to 70% of beneficiaries who need mobility devices would qualify for wheelchairs and scooters that support only intermittent use.

The industry has other concerns with the LCD:

* Beginning April 1, 2008, an ATP must conduct a face-to-face exam for certain power mobility devices. While industry sources support this idea, they don't think there are enough ATPs, especially in rural areas, to support the requirement. "And there won't be enough of those people in a year and a half, either," said Don Clayback, who heads up The MED Group's rehab network. "Our comments on the draft LCD made this loud and clear."
* The coverage criteria fail to provide for a beneficiary's current and future needs. Beneficiaries who have MS, for example, may only need group 1 chairs initially, but they will likely need a more complex wheelchair when their conditions worsens. "Why pay for a least costly chair then replace it in a year?" asked Seth Johnson, vice president of government affairs for Pride Mobility. "Talk about wasting money."

The LCD, along with the new codes, goes into effect Oct. 1, 2006. While the industry plans to work with CMS to clarify and even change the coverage criteria, there is no public comment period.

"We're going to work every angle to make modifications," Johnson said.