Home Health & Hospice Week

Wheelchair providers are still hopping mad about the so-called clarification to wheelchair coverage issued in December, but the Centers for Medicare & Medicaid Services says its ears are open.

CMS will host an Open Door Forum "listening session" March 3 that will cover the "Medicare power wheelchair benefit" -- including Operation Wheeler Dealer actions and the supposed "clarification" that the industry says is actually a restriction on coverage of the items.

The so-called clarification issued by the four durable medical equipment regional carriers "were simply restatements of the existing policy," a CMS official insisted in the Feb. 18 Open Door Forum for home care providers. "But in order to get input and hear the comments from the industry," CMS scheduled the listening session, he said.

Providers argue the articles were instead restrictions on coverage policy (see Eli's HCW, Vol. XIII, No. 3). And an attorney from Alston & Bird said in the forum that former CMS Administrator Tom Scully, now an Alston & Bird employee, was under the impression that in addition to the clarification offered in the December memos, CMS would change policy to be "more responsive to other conditions of ambulatory status for people who would otherwise not qualify for wheelchairs."

A CMS official responded that any possible change would take time.

Where Is the Dialog? 

"CMS continues to meet with the DME industry to try to find solutions to address their business needs," the agency says in its announcement of the forum.

However, CMS has failed to establish any exchange with the industry over the matter despite repeated requests, insisted Erik Sokol with the Power Mobility Coalition in the forum. "This is becoming a one-sided dialog with the industry voicing their concerns in various forums, and us getting no input from CMS," Sokol told CMS.

The listening session won't help matters since CMS won't furnish answers to participants' questions or feedback on their comments, Sokol added. A similar listening session Feb. 24 for invited industry representatives only posed the same lack of exchange, he said.

"We are trying as hard as we can to be responsive," a CMS official responded to Sokol's criticisms. "The issues are wide-ranging and there are many people trying to get responses."

Chief amongst the cash flow obstacles is medical review for wheelchair claims. "We are not in this to try to deny claims for people who really are genuinely meeting the guidelines for coverage," a CMS official insisted. In fact, suppliers are failing to respond to requests for additional documentation required by medical review, leaving CMS no option but to hold up or deny claims, the staffer said.

But it's the extensive documentation required that often keeps suppliers from responding, Sokol suggested. Collecting physicians' progress notes and other items of documentation never before required is a huge challenge. "This all takes time, then cash flow becomes a huge issue," he said.

CMS paid $65 million for K0011 wheelchairs in December 2003, CMS pointed out -- about $40 million more than in December 2000. v