Home Health & Hospice Week

Draft LCD answers some questions, raises others.

Solving a complex jigsaw puzzle is hard enough, but try making sense of one without having all the pieces before you. That's the situation mobility device suppliers now find themselves in regarding coverage policy.

Durable medical equipment regional carriers last week unveiled their draft local coverage determination for power wheelchairs and other power-operated vehicles, filling in some information gaps left by the national coverage determination released in May and the interim final rule proposed last month.

But as the clock ticks toward Jan.1implementation of the new coverage policy, important questions remain unanswered and details unaddressed.

"I think we're going to have to wait for every single piece of this puzzle before we really know what we're dealing with," Rita Hostak, vice president of government relations for Longmont, CO-based Sunrise Medical, tells Eli.

LCD Sparks Access Concerns

On the positive side, the LCD clarifies some concerns providers had regarding the 30-day timeframe between the face-to-face exam and the order for the equipment. For example, if the power chair or POV is a replacement, a face-to-face examination is not required.

But the LCD also presents problems. For instance, it requires the involvement of a trained assistive technology provider for high-end rehab--but there currently aren't enough ATPs available to meet the demand the policy will create.

"If they implement that policy as of Jan. 1, there's going to be a real issue for beneficiaries trying to access those ATPs," Hostak warns. To remedy that problem, she suggests either a phase-in period or allowing the involvement of an expert other than an ATP.

The LCD also appears to limit access to standard-use chairs and POVs unless the beneficiary needs special accessories such as drive-control options, power seating or a ventilator tray, Hostak notes.

"Based on this LCD, an active person with a disability is restricted to a very basic indoor-type power wheelchair," Hostak says. "That's a dramatic switch from what people with disabilities had access to previously."

While the coverage policy revealed to date requires clinicians to have expertise in assistive technology, it does not demand a similar level of expertise on the supplier side, Hostak says. However, the draft supplier standards to be released this week may address that issue, she notes.

The LCD also fails to give suppliers many of the details they've been asking for regarding medical record documentation specifications, points out Eric Sokol of the Power Mobility Coalition.

The PMC is urging CMS to delay implementation until April of next year to give suppliers as well as physicians adequate time to digest the policy revisions. "I don't understand why they're rushing into all these changes," Sokol tells Eli.

The comment period on the draft LCD ends Oct. 31, with the final LCD release in December, taking effect Jan. 1, 2006. The Region B and D DMERCs will hold a meeting Oct. 11 in Indianapolis to gather comments on the draft LCD. To participate by phone, e-mail draft.dmerc.lcd.comments@anthem.com for Region B and Mary.Rheinecker@CIGNA.com for Region D.

Note: The draft LCD and related information are at the DMERC Web sites: www.tricenturion.com, www.palmettogba.com, www.adminastar.com and www.cignamedicare.com.