PWC amendment: It's a 'done deal'

Sunday, December 25, 2005

WASHINGTON - Both the House of Representatives and the Senate have now approved an appropriations bill that includes an amendment halting CMS's new power mobility rule, which replaced CMNs with prescriptions and physician notes beginning Oct. 25.

The Senate approved the bill, which sets spending for health and human services and labor, late Wednesday, Dec. 21. The president was expected to sign the bill as soon as Friday, Dec. 23.

The PWC amendment, crafted by industry ally Sen. Arlen Specter, R-Pa., prohibits CMS from using resources to implement or enforce its interim final rule (IFF). It advises CMS to re-issue its rule on Jan. 1, 2006, but that date will likely be pushed back, industry sources said.

The amendment also advises the agency to hold 45-day comment and transition periods and implement a new rule no sooner than April 1, 2006.

Wheelchair and scooter manufacturers like Pride Mobility and Invacare pushed hard for the amendment for two reasons: CMS needs to clarify documentation guidelines, and it needs to do more to educate physicians, they say.

With the amendment pretty much a "done deal," according to Seth Johnson, director of government affairs for the Exeter, Pa.-based Pride Mobility, the industry now awaits word from CMS.

"We expect (the agency) to issue some type of guidance in the near term on what suppliers are supposed to do in this interim period," he said. "We've talked to CMS in the past couple of months and posed the question, 'What are you going to do if the IFR is rescinded?' They've always said, 'Until Congress moves forward, we're not going to make any changes.'"

Pending word from CMS, Johnson recommended providers continue to follow the current local coverage determination (LCD).

Cara Bachenheimer, vice president of government relations for Elyria, Ohio-based Invacare, had this advice: "Providers who are in compliance (with the IFR), should keep their operations just the way they are. It doesn't make sense to disrupt operations and then go back. More power to you, if you're up and running, and getting the documentation you need in 30 days."

For those who aren't quite up to speed, however, Bachenheimer said, she doesn't see a problem with reverting back to the CMN, at least in the short term.

Industry officials expect to sit down with CMS officials after the holidays, both Johnson and Bachenheimer said.

CMS's IFR, which went into effect Oct. 25, also requires physicians to conduct face-to-face examinations and provide suppliers with documentation within 30 days. The industry supports the face-to-face requirement, but it would like to see the 30-day timeframe extended. Suggestions range from 60 to 120 days.

All along, however, the industry's biggest concern has been what it believes to be the ambiguity of the new documentation requirements.

The amendment did not include a proposal to cut reimbursement for power mobility devices by 1.5% in 2006. A House-Senate Conference Committee dropped the proposal in mid-November.