The medical directors of the Medicare Durable Medical Equipment Program Safeguard Contractors (DME PSCs) have released a revised local coverage determination (LCD) for power mobility devices (PMD), but questions about access and equipment specifics still remain.
The revised LCD was fittingly released as the National Coalition for Assistive & Rehab Technology (NCART) was holding a legislative/funding update meeting late Wednesday afternoon, Sept. 20, during Medtrade in Atlanta.
Along with the revised LCD came a delay in its implementation date, originally scheduled for Oct. 1, 2006. At press time, implementation had been postponed until Nov. 15, 2006.
Among the LCD changes generally, if cautiously, applauded by the industry included the elimination of “downcoding” beneficiaries from Group 2 or Group 3 power chairs to Group 1 power chairs if the beneficiaries didn’t meet certain criteria. Also drawing cautious approval was the addition of the word “independently” to a requirement that a beneficiary qualifying for a Group 3 power chair be “unable to stand and pivot to transfer due to a neurological condition or myopathy.” That criterion in the revised LCD now reads, “The patient is unable to independently stand and pivot to transfer due to a neurological condition or myopathy.”
At press time, fee schedules for the new PMD codes had not been released, though government policy experts within the industry expected the information to be released imminently, and the Centers for Medicare & Medicaid Services said, via its Web site, that the fee schedules “should be available in the near future.”
But questions still remained regarding how certain parts of the LCD would be interpreted by those actually reviewing claims.
Don Clayback, The MED Group’s director of networks, called the 45-day implementation delay “a good thing,” as was the modification of the “downcoding” Group 2 and 3 language. “There are some positive steps,” he said, “but we still have some issues that I don’t think have been resolved yet. As you can imagine, there have been some conference calls back and forth as we analyze what all the language means and where there are still some gaps.”
One of those gaps, Clayback said, involves beneficiary access to higher-end assistive technology. “There’s been some improvement in the Group 2 category,” he noted. “It looks like people who qualify for the Group 2 wheelchair classification will stay in Group 2, but the concern (is) for people with more complex disabilities that should be put into a Group 3 type of wheelchair. (Their access) may still be eliminated based on the stand/pivot transfer clause that’s in there.
“The other question is to really go through each sentence in the policy to see what gray areas still remain in terms of classifications and who is going to end up within each category. What’s obvious is the stand/pivot clause is still a significant concern.”
Go to www.tricenturion.com/content/currentbulletin_dyn.cfm and look under Current Bulletins to download a copy of the revised LCD.