Home Health & Hospice Week

Now that the NCD is final, keep your eyes peeled for DMERCs' local coverage policies.

The federal policymaking process at times has been compared to sausage making - and right now some durable medical equipment suppliers feel like they're caught in the swirl of a meat grinder.

There's widespread confusion over the complex process of implementing Medicare's new national coverage determination for mobility assistive equipment. That became apparent during last month's Centers for Medicare & Medicaid Services Open Door Forum for home health/DME, when Eric Sokol of the Washington-based Power Mobility Coalition reported that durable medical equipment regional carriers have been telling suppliers they're awaiting further instructions from the agency before implementing the NCD.

"Some of the DMERCs are saying they're still applying the bed- or chair-confined standard until they get some instruction from CMS," Sokol tells Eli.

During the forum, a CMS official said he was "pretty sure" NCDs take effect as soon as they're published in final form.

In fact, Sokol and the CMS official are both correct: The NCD is final and in effect - but there's more work to be done before the policies it outlined are fully implemented on the local level.

Look for Local Policy by January

NCDs typically are not freestanding policies but require additional guidance as to how claims will be adjudicated, explains Rita Hostak of Longmont, CO-based Sunrise Medical.

The guidance normally comes with a local coverage determination written by the DMERCs, Hostak notes.

Making this NCD even more complex is the fact that it originally set out to tackle wheelchair policy but in the end addressed all categories of mobility assistive equipment: ambulatory aids, manual wheelchairs, scooters and power wheelchairs.

What to expect: The DMERCs plan to craft local policy on a category-by-category basis and currently are working on the power wheelchair piece, Hostak reports.
 
They plan to release a draft policy this month, which will be followed by a 45-day comment period. They also will hold public meetings on the policy at each of the DMERCs.

After gathering feedback, the DMERCs will finish crafting the local coverage policy, which they hope to implement along with the new wheelchair codes in January 2006, according to Hostak.

In the meantime, suppliers' worries about coverage standards are perfectly understandable, she says. After all, they have to supply equipment that costs thousands of dollars before they submit a claim that might be rejected. "That's a substantial financial risk, which is why they're so anxious to get some clarity," Hostak says.

Deadline Uncertain for Additional DME Guidance

CMS currently has in the clearance process a regulation that will address issues raised by the Medicare Modernization Act such as the face-to-face exam, the revised certificate of medical necessity, who can prescribe a scooter, etc.

During last month's home health open door forum, a CMS spokesperson said the agency and the federal Office of Management and Budget were in "active discussions" over the reg. The OMB's involvement indicates the discussions may involve Paperwork Reduction Act concerns, Sokol notes.

At this point, however, CMS cannot say exactly when the regulation will be released to the public.

"Sometimes clearance goes on for a long time, and sometimes it doesn't," the spokesperson says.