Power mobility devices: CMS clarifies coverage

Tuesday, October 31, 2006

WASHINGTON - CMS clarified its coverage criteria for power mobility devices in September, but the rehab industry hopes the agency won't stop there.
After numerous discussions with the industry, CMS eliminated language that would have automatically downcoded beneficiaries from more to less complex PMDs. The agency also further defined its "stand-and-pivot transfer" requirement for the most complex PMDs.
"The clarifications are a big step in the right direction," said Cara Bachenheimer, vice president of government relations for Invacare. "But the local coverage determination is still not crystal clear."
CMS also delayed implementing its new codes, coverage criteria and pricing until Nov. 15 (See story this page).
While the rehab industry now feels comfortable that it's not the medical directors' intent to downcode beneficiaries from Group 2 to Group 1 PMDs, it would feel more comfortable if the LCD reflected that more explicitly. Industry sources pointed out that CMS eliminated the "least costly alternative determination" language in some parts of the LCD but not others.
"The downcoding cloud still hangs over the current LCD," said Don Clayback, who heads up The MED Group's rehab network. "It needs to be more black and white."
Without further clarification, providers won't know where they stand in the event of medical reviews or audits, industry sources said.
The rehab industry feels CMS made even less progress in reshaping its stand-and-pivot transfer requirement. The agency added the word "independently" to indicate that only beneficiaries who can't complete transfers alone qualify for Group 3 PMDs. But the industry believes transfers shouldn't be used as a barometer at all.
"We need a different criteria," said Tim Pederson, CEO of WestMed Rehab and vice chairman of AAHomecare's rehab council.
Clinicians at Invacare were working on alternative criteria to share with CMS, Bachenheimer said.