Rehab Group: CMS needs broader view of PWC issues

Saturday, July 31, 2004

WASHINGTON - In contrast to CMS’s three-pronged plan, the National Coalition for Assistive and Rehab Technology is promoting a more “holistic” approach for tackling the glut of power wheelchair issues that have arisen over the past year.

In its comments to the Interagency Wheelchair Work Group that is formulating clinical guidance for CMS’s national coverage policy, NCART urged the group to broaden its scope beyond interpreting bed or chair confined.

“This is in contrast to what [CMS] has been doing to this point,” said Sharon Hildebrandt, NCART’s executive director. “CMS needs to take a broader view of the whole issue of coverage and codes and pricing. They can’t create the codes themselves in a vacuum. They can’t create the coverage policy in a vacuum because everything is intertwined.”

The work group, which was established in June, is made up of 19 people from HHS, the VA, the NIH and the Department of Education. It hopes to deliver a final draft of the clinical coverage guidelines for power wheelchairs by the end of the year. The group is accepting comment for the first draft, due by mid October, until September 1.

NCART’s comments, which were submitted in June, say that CMS “traditionally segregates” work on issues related to coding and coverage. For example, while the work group creates new coverage guidelines this year, a new code set is not expected until July 2005.

“When [the Interagency Wheelchair Work Group] is talking about bed or chair confined, there is so much more that goes into that,” said Hildebrandt. “They have to look at the functional abilities of the beneficiary, and they also have to look at the codes to see if the codes correspond to the functional abilities.”

Hildebrandt also said the bed- or chair-confined terminology at the root of the group’s work could become obsolete in the future as it draws more scrutiny from the industry.

“Even though they are saying they can’t do anything about it right now, [bed or chair] confined is something they need to think about when developing their clinical guidance because it is certainly something the industry is going to start pushing along with consumer and disability groups,” she said. “They have to have in mind that bed- or chair-confined may be changed.”

Included in comments is a “building block” concept for addressing wheelchair issues and curbing fraud and abuse. Among NCART’s suggestions: require evaluations by a physical or occupational therapist; create HCPCS codes that adequately describe functional mobility; and ensure that the clinical indicators align with existing wheelchair technology.

“NCART strongly believes that synchronizing the various elements outlines in these comments will result in appropriate access to technology as well as a reduction in abuse of the Medicare program,” stated NCART’s document to CMS.