RAMP to CMS: Develop a thoughtful PWC rule

Sunday, January 22, 2006

WASHINGTON - With an additional three months before it must implement a new power mobility rule that replaces the CMN with a physician's prescription, CMS has an opportunity to do everything needed to ensure that beneficiaries have access to these products, Restore Access to Mobility Partnership stated in a press release last week.

In its release, RAMP urged CMS to consider the recommendations proposed by clinicians, consumers, suppliers and manufacturers. These stakeholders, as well as physicians and advocates for people with disabilities, want a policy and regulations enacted that will allow Medicare beneficiaries to receive mobility equipment that can increase their mobility, stated RAMP, a coalition of wheelchair providers and manufacturers.

CMS enacted its interim final rule on Oct. 25. The rule replaced the CMN with a physician's prescription and required providers to keep the physician's notes on file. President Bush signed on Dec. 30 a Labor HHS Appropriations Bill, which includes provisions saying that CMS must suspend enactment of its IFR until a new regulation is issued and implemented. The new rule is to be implemented by April 1, 2006. The House and Senate included the provisions after hearing concerns from stakeholders that the IFR was somewhat flawed and causing confusion among physicians, beneficiaries and suppliers.

Specifically, RAMP recommends that CMS:

-- Issue instructions clarifying that physicians may respond to a series of questions that are based upon the May 5, 2005 National Coverage Determination for Mobility Assistive Equipment, as long as the physician provides all responding information. In many cases, physicians are not educated on the coverage criteria; suppliers typically bear the burden of providing that education to prescribing physicians.

-- Work with national and state medical groups by providing articles explaining the new coverage policy and physician documentation responsibilities, as well as host seminars at their meetings.

-- Create a Web-based education program to explain the new coverage policy, regulations and physician documentation responsibilities.

-- Extend the 30-day requirement between the date of the face-to-face exam between physician and Medicare beneficiary and the date that the physician provides the supplier with the supporting documentation to 60 days. Oftentimes, the 30-day timeframe is not feasible.

Furthermore, RAMP stated, it is important for CMS to affirm that the documentation expectations outlined in the IFR will not be applied during a pre-or post-payment audit on claims for services provided during the transition period from Oct. 25, 2005 to the effective date of the new regulation.