On May 5, 2005, the Centers for Medicare and Medicaid Services (CMS) implemented new national coverage criteria for mobility assistive equipment including power wheelchairs and scooters. This new National Coverage Determination (NCD) modernizes the coverage policy by removing the archaic “bed or chair confined” standard and replacing it with a functionally based standard for coverage. The new Medicare coverage standard is based on a patient’s ability to participate in “mobility related activities of daily living”. Mobility related activities of daily living include: dressing, grooming, toileting, bathing, and eating.
This new National Coverage Determination came about through the combined efforts of Pride Mobility Products Corp, and many providers in the industry along with our members of Congress, as well as consumer organizations and other industry representatives, working in collaboration with CMS to develop a new coverage standard that paints an accurate picture of when someone qualifies for mobility equipment.
Today, a new coverage policy is in place. This policy also outlines the importance of the physician/provider relationship which is pivotal in ensuring patients receive the proper care to meet their medical needs. However, some additional concerns remain that need to be addressed with CMS. One concern is that CMS, through its Medicare contractors, may continue to deny patient access to medically necessary mobility products due to an unclear documentation standard. Although CMS has issued a new National Coverage Determination, CMS also released an Interim Final Rule for Power Mobility Devices (PMDs) in October 2005 that significantly altered how documentation is gathered to support medical necessity for PMDs. This interim final rule has since been delayed until April 2006 due to the combined efforts of the mobility industry working with Members of Congress to provide more time for physicians to become educated on these new important changes as well as for CMS to provide a clearer documentation standard for PMDs. During the delay period the industry is advocating for CMS to provide documentation clarification so physicians and providers have an equal understanding of the standard that must be met for Medicare coverage purposes.
One additional concern that remains with the coverage policy is the requirement that Medicare only cover equipment for individuals with a medical need it for “inside the home” only. Current regulations state that Medicare only reimburse for equipment that is medically necessary for use inside the patient’s home. However, consumer organizations have long argued that this is a misinterpretation by CMS and that the true meaning of the rule is to differentiate the coverage of equipment needed for the home and community use (which would offer separate reimbursement) and that needed in an inpatient facility (hospital, nursing facility, etc.). Pride will continue to support the efforts of consumer organizations and clinician groups to address the “in the home” restriction and assure all patients receive medically necessary mobility products.
Pride appreciates the hard work put forth by CMS to develop the new coverage policy. However, we will continue to address these additional concerns in order to assure Medicare provides sufficient time for physician education and a clear documentation standard that ensures physicians, clinicians, and providers understand what is required of them to justify medical necessity of PMDs. In order to assure this occurs properly, you can contact your local Congressmen as well as Medicare officials to voice your support. Contact your local Congressman here. In addition, if you are a member of AARP, you can express your concerns to AARP.