PWC amendment: It's a done deal

Tuesday, January 31, 2006

WASHINGTON - The House, Senate and President Bush have all approved an appropriations bill that includes an amendment halting CMS's new power mobility rule, which replaced CMNs with prescriptions and physicians notes beginning Oct. 25, 2005.
The president signed the bill, which sets spending for health and human services and labor, Dec. 30.
The amendment, crafted by industry ally Sen. Arlen Specter, R-Pa., prohibits CMS from using resources to implement or enforce its interim final rule. The IFR also requires physicians to conduct face-to-face examinations and provide suppliers with documentation within 30 days.
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.
The industry now awaits word from CMS. The amendment advises the agency to re-issue its rule and hold 45-day comment and transition periods. It also requires CMS not to implement new rule before April 1, 2006.
"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," said Seth Johnson, director of government affairs for the Exeter, Pa.-based Pride Mobility. "We've talked to CMS in the past couple of months and posed the question, 'What are you going to do if the IFR is rescinded?'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 expected to sit down with CMS officials after the holidays, both Johnson and Bachenheimer said.
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 always 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.