Home Health & Hospice Week

Lawmakers raise concerns about policy's subjectivity, consistency.

Three politically powerful U.S. legislators have joined the power mobility industry's efforts to slow down a runaway regulatory process.

Sens. Charles Grassley (R-IA), Rick Santorum (R-PA) and Arlen Specter (R-PA) on Sept. 29 wrote to Health & Human Services Secretary Michael Leavitt and Centers for Medicare & Medicaid Services Administrator Mark McClellan asking for a postponement of new rules governing Medicare reimbursement for power mobility devices.

The Oct. 25 implementation date for the interim final rule "appears to be unrealistic," Grassley writes. Final comments on local coverage determinations are not due until Oct. 31, and the durable medical equipment regional carriers won't finalize the coverage decisions until late November or implement new codes until next April, he notes. "It seems as if CMS is trying to finish a puzzle with some essential pieces missing," he observes. Scripted Form Needed To Replace CMN Eliminating the certificate of medical necessity without providing a scripted form in its place could "open the door to fraud, confusion, and subjectivity," Grassley says.

CMS should consider a scripted prescription or similar form with open-ended questions that directly link to the national coverage determination, he advises. Such a form ought to include an attestation certification referencing the False Claims Act to improve program integrity, he adds.

In addition, the agency must work with the DMERCs to decrease subjectivity and ensure consistency as they develop their LCDs, Grassley urges. He closes his letter with five queries for CMS to answer by Oct. 11, including questions on the add-on G-code payment, competitive bidding and the quality standards.

Santorum and Specter raise similar concerns in their letter. They ask CMS to delay implementation of the interim final rule until April 2006 and new codes until July 2006.

"The absence of a reasonable period for advance preparation to the change in rules may overwhelm PMD providers and manufacturers striving to comply and remain commercially viable," Santorum and Specter write. "We are hopeful that an alternative legislative remedy will not be necessary to implement such a delay.