Panel: CMS 'ignored' our recommendations

Sunday, September 10, 2006

WASHINGTON - The Technical Experts Panel that worked with CMS to develop new codes for power mobility devices sent the secretary of the Department of Health and Human Services a letter last week saying its recommendations were "ignored."

"Many of our most critical recommendations were ignored or modified to the point that they no longer represent our intent as panel members," stated the letter, which was signed by eight of the panel's 14 members.

At the crux of the panel's concern: CMS asked the panel to develop different groupings of wheelchairs, including a grouping of chairs meant for limited use-group 1 chairs. When CMS released the accompanying coverage criteria, a picture of how the new codes would work in practice began to take shape, and the panel didn't like what it saw. There was a chance that nearly all beneficiaries, including those in the early stages of serious conditions, would be downcoded to group 1 chairs.

"That was a big disappointment," said Simon Margolis, a panel member and vice president for clinical and professional development for National Seating & Mobility. He pointed out that the group 1 chairs are meant to be used only two to three hours per day.

Panel members have other concerns. The LCD, for example, denies coverage for features that allow beneficiaries to use power mobility devices outside the home. The LCD also uses stand-and-pivot transfers as the barometer for qualifying for a group 3 chair.

"That, to me, is way off base," Margolis said.

Mark Schmeler, a panel member and faculty member at the University of Pittsburgh, agreed: "In some instances, (a stand-and-pivot transfer) is a legitimate criteria, but it shouldn't be used as the only criteria. I have patients who can perform a transfer but still need multiple seat functions and group 3 chairs."

In its letter, the panel asks the secretary to urge CMS to work with panel members and other stakeholders "to fix the significant problems with the interpretation of the PMD code set before they are implemented."

The codes, the LCD and a yet-to-be-released fee schedule are all scheduled to take effect Oct. 1.