Suppliers of power mobility equipment say CMS' new interim final rule on the devices creates a system that is more complicated than the one it replaces and should not be implemented until next April.

The rule would replace the "bed-or-chair confined" criterion with functionality requirements to determine whether beneficiaries are eligible to receive a power wheelchair or scooter. It was published Aug. 26 and is scheduled to go into effect Oct. 25 (¹ Also see "CMS Overhauls Wheelchair Reimbursement In Interim Final Rule" - Medtech Insight, 29 August, 2005. p. 26).

During a CMS-sponsored open door forum Sept. 13, suppliers and manufacturers told the agency that healthcare providers will not be ready to implement new billing and prescription procedures by the October date.

The deadline "virtually assures thousands of physicians will not be educated or well versed in information they will now need to itemize and document to establish medical necessity," said Dan Meuser, president of Pride Mobility Products. "Who's going to be doing the educating and to what degree will it be done?"

In a fact sheet posted on CMS' website last month, the agency said it would publish an article in Medlearn Matters to describe healthcare practitioners' new responsibilities.

Under the new rule, physicians and other practitioners must conduct face-to-face interviews with beneficiaries and write prescriptions for power mobility devices. The prescriber also must submit supporting documents from the beneficiary's medical history that support the need for the vehicle. The documents would replace the Certificate of Medical Necessity (CMN), the form previously used to order mobility devices.

According to CMS, "the CMN did not work as well as originally hoped, because important functional details in the medical record have frequently not been included in the CMN."

Several stakeholders indicated their preference for the CMN. They said the new rule complicates the provider's job by replacing one piece of paper, the CMN, with an unspecified number of documents from the patient's medical record.

Scooter Store CEO Doug Harrison told CMS that the new documentation requirements place inappropriate responsibility on suppliers.

"The [rule] appears to make the supplier, rather than the treating physician, responsible for making the ultimate medical necessity determination based upon the documentation received from the physician," Harrison said.

"The three proposed documentation elements are all very subjective as opposed to the clearly objective CMN that this rule eliminates."

According to Harrison, suppliers could be denied reimbursement for a mobility device if CMS decides that a physician did not provide adequate documentation of the beneficiary's need.

Richard Lawlor, director of CMS' open door initiative, said the rule does not require wheelchair providers to make a diagnosis or write a prescription.

However, suppliers "do have to find, between the time a prescription is made and it is supplied, an ability to translate that prescription into a physical piece of equipment," Lawlor said. "That's the business you're in."

Harrison joined other forum participants in requesting that implementation of the rule be put on hold until April 2006. They argued that the national coverage decision should be implemented only after the four durable medical equipment regional carriers (DMERCs) issue local coverage determinations.

Drafts of those local coverage determinations were issued by the DMERCs Sept. 14. The drafts will provide guidance to suppliers on what types of documents from a beneficiary's medical history can establish medical necessity for the device. Final implementation is scheduled for early 2006.

Equipment providers pointed out that if CMS holds to the current Oct. 25 deadline, they will be forced to adjudicate claims without formal guidance from regional carriers.

Power Wheelchair Suppliers Spar With CMS Over New Regs

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