Question & Answer

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Sunday, February 29, 2004

Hoover addresses industry concerns
NASHVILLE, Tenn. - Region D Medical Director Dr. Robert Hoover is not a mind reader. He just appears that way based on his Question & Answer interview regarding CMS’s coverage clarification for power wheelchairs. Hoover posted the Q&A to www.cignamedicare.com in late January, and it’s not by chance that the questions he answers mimic those being asked throughout the HME industry. They are the industry’s questions, posed to him by Pride Mobility Products, Invacare and others up in arms over the December clarification. In abbreviated form, excerpts from Hoover’s Q&A follows, peppered here and there by a few questions HME News asked him directly.

HME News: On December 9, 2003, the DMERCs issued a bulletin entitled “Power Wheelchairs and POVs - Policy Clarification and Medical Review Strategy”. Isn’t this bulletin article really outlining a new, more restrictive power mobility policy?

Hoover: No, the same national power mobility policy has been in place since at least 1986. Moreover, Region D has historically taken a strict approach to the enforcement of this policy, consistent with the December bulletin.

HME: The 12/9/03 article states that a beneficiary must be nonambulatory in order to qualify for power mobility. How do you define nonambulatory?

Hoover: Region D considers nonambulatory to mean that the beneficiary is totally unable to walk. We will, however, consider that a beneficiary meets this requirement if their ability to ambulate is limited to taking one or two steps for transfers.

HME: With this clarification it appears you adopted the most conservative interpretation. Why?

Hoover: When you start getting into, ‘What if they can walk eight to 10 steps? What if they can walk from their kitchen to their bedroom, but they can’t walk more than that without stopping to take a breath?’ it starts leading you down a slippery slope that makes it harder for the supplier to understand who qualifies and who does not qualify.

HME: Why do you think there was a difference in interpretation of the power wheel chair coverage criteria from region to region?

Hoover: CMS gives us a lot of leeway sometimes in how we interpret policy. In Region D, I always thought it was clear. As far as the other regions go, they may have interpreted it at some points in a strict fashion and sometimes not. When we started talking we realized there were some areas where we were not as consistent as we would have liked.

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