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Regulations:

EXPECT WHEELCHAIR DOWNCODES AFTER SCOOTER REG FINALIZED

Published on Thu Jul 15, 2004

Change in prescribing requirements slated for September.

A rule making it easier to order scooters could make it harder for suppliers to secure power wheelchair payments.

Current regulations have different requirements for who can order wheelchairs versus scooters, notes a Centers for Medicare & Medicaid Services representative. A forthcoming regulation included in CMS' Semiannual Regulatory Agenda "will simplify that," the rep tells Eli.

The change will allow all physicians, instead of just specialists, to order scooters. It is part of CMS'10-point plan for Operation Wheeler Dealer (see Eli's HCW, Vol. XII, No. 32).

Attorney Timothy Webster expects to see a rash of power wheelchair downcodes once the regulation takes effect. The durable medical equipment regional carriers will likely downcode K0011 wheelchairs to less expensive scooters, predicts Webster, with Amarillo, TX-based Brown & Fortunato.

Medicare "will pay scooter prices for wheelchairs," Webster forecasts. The new rule will make it easier to deny pricier wheelchair claims.

But just how easy that may be remains to be seen. It depends on how the regulation is written, says attorney Cara Bachenheimer, vice president of government relations for Invacare Corp. in Alexandria, VA.

Industry observers are surprised CMS has delayed this regulation, since it was part of the agency's highly touted crackdown on power wheelchair fraud. CMS originally slated the reg for release last February.

"It's not real complicated," Webster notes, so the reason for the delay isn't evident.

"This reg is going through the clearance process, which means it could come out next week or in October," Bachenheimer points out. CMS sets a September deadline for the interim final rule.

Other DME items in the agenda include:

  • Competitive bidding. CMS says it will issue its proposed rule on competitive bidding in March 2005, but that may be overly optimistic. Bidding planning "is still in the early stages," Webster says, with CMS soliciting nominations for the bidding oversight committee only last month (see Eli's HCW, Vol. XIII, No. 21).

    It's common for items on the regulatory agenda to be pushed back, and Webster wouldn't be surprised for the bidding proposed rule to be one of them. Bidding will be "a tremendously complicated system," he predicts.

    CMS notes it must issue the proposed and final rules at least six months prior to the Jan. 1, 2007 implementation date for the new payment system.

  • Supplier standards. New supplier standards for home oxygen, therapeutic shoes and home nutrition therapy have been long delayed, and that's no exception in this agenda. CMS plans to publish a proposed rule on the issues in September, it says this time.

  • RADs. CMS is pushing ahead with its proposal to switch respiratory assist devices with bi-level capability and back-up rate from the frequent and substantial servicing payment category to the capped rental category. The industry railed against the switch, which could reduce payments for the ventilators by as much as $30,000 a piece, when CMS proposed the idea last summer (see Eli's HCW, Vol. XII, No. 31).

    But suppliers do have some breathing room on the change. CMS sets the final rule date in August 2006.

  • DMERCs. CMS' efforts to introduce flexibility into the DMERC contracting structure are still a long ways off, with a final rule slated for March 2007. The agency issued a proposed rule on the change in March (see Eli's HCW, Vol. XIII, No. 13).

    Editor's Note: The agenda is at www.access.gpo.gov/su_docs/fedreg/a040628c.html under Health and Human Services Department.

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