DMERCs Issue 'Bridge' LCD
ATLANTA--The DMERCs issued revised draft local coverage determinations for mobility devices on Tuesday, bringing current codes into step with CMS' national coverage determination issued in May.

The LCD was originally scheduled to be implemented Jan. 1, 2006, but will be delayed to take effect at the same time as the agency's new power mobility codes, CMS announced on Oct. 14 (see HomeCare Monday, Oct. 17).

While there is no definite timeframe associated with the delay, SADMERC Medical Director Dr. Doran Edwards told Medtrade attendees last week that he anticipates the new PMD codes could possibly be ready by sometime in mid-2006. According to Edwards, "The length of time for wheelchair manufacturers to do the test we require, whatever that turns out to be, will drive when the codes become effective."

A CMS technical advisory panel on the codes (see story above) has three interim deadlines for completing its work, according to Edwards. The first--April 1, 2006--is "not going to happen," he said, and a July 1 date is "iffy but possibly doable." But a target of October 1 "has real potential."

In the meantime, the revised LCD will function as a bridge policy for continued use of the current codes--K0010, K0011, K0012, K0014 and E1230--based on the NCD until the new codes become effective. As providers have been requesting since the NCD was issued May 5, the revision includes claims documentation guidance based on CMS' new algorithmic approach to coverage of mobility assist equipment.

Edwards noted, however, that the existing LCD still has an open comment period. "Even though it is now withdrawn," he pointed out, "that policy will very likely be the one that [CMS] will go back and use as the template to tie to the new codes whenever we finish those, so your comments are important."

He urged all stakeholders to "go ahead and turn your comments in before the deadline."

To view the revised LCD, visit www.tricenturion.com.

Interim Final Rule Takes Effect Tomorrow
While most industry-watchers viewed the revised LCD and power code delays as good news, some pointed out that CMS' interim final rule on power mobility is still scheduled to take effect Oct. 25 (tomorrow) as planned--unless an effort by the Power Mobility Coalition to delay its implementation is successful.

The organization filed suit against the government Oct. 13 and is asking for a preliminary injunction that would delay the rule, which eliminates the certificate of medical necessity for Medicare reimbursement of power wheelchairs and scooters.

According to the PMC, the rule "would decrease beneficiary access to PMDs, increase the regulatory burdens placed upon physicians and irreparably harm suppliers of PMDs." The rule also includes a requirement that physicians or other treating practitioners conduct a face-to-face examination of patients when prescribing PMDs, and expands the types of physicians and practitioners who may prescribe power operated vehicles or scooters. (See HomeCare Monday, Aug. 29.)

"Since the rule is scheduled to take effect a full month before comments are due, it is difficult to believe that CMS could consider public comment and modify the rule at a later date," stated PMC Director Eric Sokol.

A court hearing on the matter is scheduled tomorrow.

CMS Creates One-Stop Shop for Mobility Info
BALTIMORE--Along with its Oct. 14 announcement that new power mobility codes will be delayed, CMS has created a new resource for information related to power wheelchairs.

Rather than having to access them separately through the Federal Register or multiple CMS manuals, a new one-stop Web site lists a number of documents that are relevant to key initiatives and changes regarding PMD coverage and payments that the agency has rolled out this year, beginning with its NCD for MAE in May.

The site includes guidance documents with click-throughs such as:

--the MAE National Coverage Determination;
--the MAE coverage algorithm;
--the recommendation of the Interagency Wheelchair Work Group;
--the PMD Interim Final Rule;
--a fact sheet on the PMD IFC;
--Q&As on the MAE NCD, the PMD IFC, elimination of the power mobility CMN, and the DMERCs' LCD process;
--documentation requirements in the DMERCs' draft LCDs for PMDs; and
--CMS MedLearn articles associated with these initiatives.

While the Web site is a reference for all mobility stakeholders, according to officials, the documents it contains are particularly relevant for PMD prescribing physicians and practitioners and can be a useful tool for suppliers who may need to educate referring physicians on the changes--without having to navigate the CMS site to find all the details.

The new Web site is available at www.cms.hhs.gov/coverage/wheelchairs.asp.

HomeCare Announces 2005 HomeCaring Award Recipients
ATLANTA--HomeCare is pleased to announce three recipients of the 2005 HomeCaring Award, given in recognition of distinguished service to the home medical equipment industry: Rita Hostak, vice president of government relations for Longmont, Colo.-based Sunrise Medical; Michael Marnhout, president and CEO of Bluegrass Oxygen, Lexington, Ky.; and Randy Wolfe, president and CEO of Lambert's Health Care, Knoxville, Tenn.

Co-sponsored by Medtrade, the awards were presented at the industry trade show last week during a Tuesday night reception at the Georgia World Congress Center. Jack Evans of Malibu, Calif.-based Global Media Marketing served as master of ceremonies for the event, which honored individuals and companies whose work in HME has elevated them to the highest level.

The 2005 recipients were chosen from nominees submitted by HomeCare's readers--from all aspects of the industry--and judged by a panel of seven industry professionals.

"HomeCare is proud to acknowledge those whose tireless efforts further the goals of the industry in serving the nation's home-based patients," said Editor-in-Chief Gail Walker. "The HomeCaring Awards are only a small token in recognizing the contributions of so many individuals whose exemplary service has made the entire home care community a better place and who challenge the rest of us to do better ourselves."

Medtrade donated proceeds from the reception in a $5,000 check to Atlanta's Shepherd Center, the country's largest catastrophic care hospital specializing in the treatment of people with spinal cord injury and disease, acquired brain injury, multiple sclerosis and other neuromuscular disorders and urological problems.

Look for profiles of the 2005 HomeCaring Award recipients in upcoming issues of HomeCare magazine.

Heard at Medtrade
On the DMERCs' revised LCD for power mobility: "What's good about [the revised LCD ] is that it has some pretty good documentation guidance. It lists questions that need to be answered in the documentation that apply specifically to the coverage criteria. So, you'll be able to know if you have this information once you get [documentation] back from the doctor or from the OT or PT assessment. At this point, this is the best documentation guidance we've seen as far as coverage."
--Kevin Quaglia, general manager, industry affairs, Pride Mobility Products, Exeter, Pa.

On the mobility LCD and coding delay: "The delay in the power wheelchair HCPCS codes and the draft LCD with power mobility is a significant delay for the industry, and I think allowed us to really dodge a bullet relative to what was getting ready to happen to our industry. The real, positive aspect is that we get to go back and make sure that the HCPCS codes align with the way clinicians prescribe technology, the way consumers utilize technology, and then to ensure that the LCD that comes out truly aligns with those clinical needs. In addition, it is going to afford us an opportunity potentially to change the entire processing template by which CMS determines new HCPCS codes."
--Rita Hostak, vice president, government relations, Sunrise Medical, Longmont, Colo.

On growing business: "We're looking at all of our product lines and looking at expanding in cash. Any direction other than Medicare is a good direction at this point, not counting on only Medicare dollars. The retail area has been good for us, so we're wanting to expand that, whether it's cash power ... or the whole variety of products [like] support stockings and wellness items that we're looking at to continue the cash flow."
--Kim Gustafson, sales/marketing manager, Health E-Quip, Hutchinson, Kan.

On supplier quality standards: "It's very scary with accreditation and the new standards that Medicare has come up with. We're in a small area, so I think we're going to have a little more time to think about it and deal with it, but we're going to have to get a lot more efficient and stay on top of our business more and more every day. We think HME is going to be a growth area for our pharmacy. About 20 percent of our business now is HME--hospital beds, home oxygen, CPAP, wound supply, just about everything--and we would like to grow that."
--Chris Staker, owner, Staker's Service Drugs, Portsmouth, Ohio

On the shape of the industry: "We have seen an inordinate amount of proposed rules come out from CMS recently: accreditation, power mobility, competitive bidding coming up and so forth. If there's any consistent thread, their new approach seems to be to have a huge quantity of incredibly picky rules focusing on ... financial deep pockets and quality details that impose an awful lot of burden on the infrastructure to manage. It's almost as if there's a subtext to all of these rules that says 'we're trying to steer the industry to only have in it the kind of suppliers we want in it' ... and if you're small and you're not sufficiently well funded, you won't be around in five years. The government and CMS in particular suggest that so much of what they're requiring these days is in order to curb fraud and abuse. But when I look at it with a more cynical eye, it seems that 'curbing fraud and abuse' is a euphemism for 'saving money.'"
--Neil Caesar, Health Law Center, Greenville, S.C.

On provider productivity: "If competitive bidding goes through in its current form, there will have to be a whole new level of sophistication out there for providers to survive. That sophistication is going to have to be manifested in business operations and increasing productivity every single day, not just doing it now but constantly reevaluating how things are done and finding better, cheaper and faster ways to do things--and to be able to document that while maintaining quality care and profitability."
--Bently Goodwin, CEO, RemitData, Dallas, Texas

On the MMA: "With the Medicare Modernization Act, it's survival of the fittest, and there's nothing you can do about it except figure out how to [deal with it] or close up shop. When the time comes, we'll formulate plans on how to deal with it, but right now, I'm not going to let what's coming up in the more distant future affect what our immediate future is. I'm here shopping to stock out a new store, and if I can't get involved in competitive bidding, I'll pull out and go to over-the-counter sales ... There's more than one way to skin a cat, and you have to eat an elephant a little bit at a time."
--Justin Rogers, general manager, Primary Medical Supply, Midland, Texas

On reworking the power mobility codes: "This is the most open, collaborative effort that CMS has ever done on a single DME device ... and if it works, it may very well set the stage for how we will do changes for large coding sets in the future as we go closer to competitive bidding."
--Dr. Doran Edwards, medical director, SADMERC

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