CMS Issues Final Rule on Power Mobility Conditions of Payment

The Centers for Medicare & Medicaid Services (CMS) has released the final rule for Medicare conditions of payment for power wheelchairs and power-operated vehicles/scooters. The final rule, published in the Federal Register on Wednesday, April 5, is scheduled to go into effect on June 5, 2006.

Among the major points of contention when the interim final rule for conditions of payment was released last summer was the requirement that a power mobility device (PMD) prescription had to be written, signed and dated by the physician performing the necessary face-to-face examination, then received by the mobility/rehab supplier within 30 days. Input during the comment period "stated that in practice, it is difficult to obtain all of the needed documentation from the prescribing practitioner within 30 days of the face-to-face examination, especially if the beneficiary has a complex condition requiring additional evaluation for the fitting of the device and appropriate accessories," CMS said in its final rule response. DME suppliers had reportedly been concerned that they would not receive the prescription within the allotted time if the client had to, for instance, be assessed by a physical therapist.

CMS agreed: "We have extended the allowable timeframe from 30 days to 45 days," the agency said in comments to the final rule. "CMS believes the additional 15 days is a reasonable compromise to accommodate the workflow between the supplier and physician or treating practitioner without seriously compromising the beneficiary's need for the expedient and efficient obtainment of necessary durable medical equipment, and CMS' need to ensure timely administration of the DME benefit while minimizing fraud and abuse."

A Medicare beneficiary discharged from a hospital would not need a separate face-to-face examination assuming that he was examined while hospitalized, and that the examining physician is the one who wrote the PMD prescription. For more convenient record-keeping, CMS said, the prescription would be valid if it's received by the DME supplier within 45 days of the beneficiary's discharge from the hospital, even if the examination took place before the day of discharge.

Physicians and treating practitioners may order PMD accessories without conducting face-to-face examinations of beneficiaries, CMS added.

Suppliers fared less favorably on perhaps the other most significant concern: the elimination of the Certificate of Medical Necessity (CMN) and the question of whether or not CMS would instead specify the types of documentation and justification that suppliers would need to guarantee Medicare payment.

In eliminating the CMN, CMS commented that the CMN "does not reliably accomplish its original purpose with regard to PMDs. The CMN did not serve to help physicians better document their patients' critical needs for a PMD, it did not serve to ensure that beneficiaries always received appropriate equipment, and it did not serve as an effective deterrent to fraud and abuse."

But CMS declined to name a document or documents to take the place of the CMN, or to offer an exact description of the type of documentation a supplier would need to secure in order to guarantee he would be reimbursed by Medicare for power mobility equipment. CMS instead said it will now require physicians to provide "written prescriptions and submit copies of relevant existing documentation from the beneficiary's medical record, rather than having to transcribe medical record information onto a separate form such as a CMN."

CMS acknowledged that people commenting on this portion of the interim final rule "asked that CMS create more specific guidelines that would outline all the documents needed from the patient's medical record or create a template to capture the information that CMS determines is medically necessary to justify the prescription." But CMS refused, saying, "CMS cannot develop an all-inclusive list of documents or information that Medicare contractors may request during audits... There is no set volume of documentation that, taken alone without regard to substantive content, will guarantee that the beneficiary's clinical condition meets the conditions for payment."

Some commenters reportedly expressed concern over the learning curve for physicians, who under the final rule will potentially have to submit additional documentation to support their PMD prescriptions, or will have to learn more specifically about various PMDs in order to write appropriate prescriptions. Overall, however, CMS expressed optimism for physicians' understanding of the final rule and its requirements.

CMS also declined to address a number of submitted comments that the agency deemed outside its jurisdiction or outside the final rule in question. CMS declined comment on the current in-the-home restriction, the difficulty for beneficiaries of obtaining face-to-face examinations if they have mobility impairments and physicians do not make house calls, and the suggestion that rehab seating and mobility suppliers be listed on the National Registry of Rehabilitation Technology Suppliers (NRRTS).

For a copy of the entire document of conditions of coverage for payment of power mobility devices, go to www.aahomecare.org.

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