CMS Proposes New Wheelchair Coverage Criteria, Announces Wheelchair Codes
In a step to redefine the coverage criteria for mobility assistance equipment (MAE), CMS released a draft proposal outlining the adequate evidence needed to determine MAE as reasonable and necessary. CMS cites characteristics of beneficiaries of MAE as those “who have a personal mobility deficit sufficient to impair their performance of mobility-related activities of daily living such as toileting, feeding, dressing, grooming, and bathing.” CMS also proposes to delete the “bed or chair confined” criterion currently used to determine if a wheelchair is reasonable and necessary. Medicare’s proposed coverage criteria would rely on clinical guidance for evaluating whether a beneficiary needs a device to assist with mobility and, if so, what type of device is needed. This new approach would replace an older, more rigid standard that relied on whether the patient was “nonambulatory” or “bed or chair confined.” CMS is requesting public comments on this proposed decision memorandum pursuant to Section 731 of the Medicare Modernization Act.

CMS is also establishing new billing codes for power wheelchairs and scooters to assure that Medicare pays appropriately for these devices. It is expected that reimbursement from the Medicare perspective would reflect increasing payments for increasing functionality. The existing power wheelchair codes (K0010, K0011, K0012, K0014) will be discontinued with no grace period and with no crosswalk of products. The new codes will be in effect as of January 1, 2006.

HHS Secretary Leavitt Highlights Home Care
In his first speech as Secretary of Health and Human Services (HHS), Michael Leavitt stressed the importance of home care in delivering cost-effective care in the Medicaid system. Speaking to the World Health Care Congress in Washington, DC, recently, Leavitt echoed last year’s HHS emphasis on rebalancing institutional care with home and community-based care through the New Freedom Initiative and other programs. He cited the emphasis on home care in Vermont’s Medicaid program as a way to control spending and expand access to health care. Leavitt also described Medicaid as rigid, inflexible, inefficient, and unsustainable.

Physician Pay-for-Performance Program Launched
CMS recently announced that 10 large physician groups across the United States will participate in the first pay-for-performance initiative for physicians under the Medicare program. The Physician Group Practice demonstration is designed to give physician groups an opportunity to demonstrate that “improving care in a proactive and coordinated manner also saves money.” Bruce Hamory, MD, chief medical officer of Geisinger Health System, one of the physician groups selected for the demonstration, said, “The success of the project depends heavily on the efficient use of home care.”

MED Group Announces New Members
The MED Group, Lubbock, Tex, recently appointed Home Care Specialists, Haverhill, Mass, to the Group’s full service network, and Michael’s Medical, Lincoln, Neb, joined its purchasing network.

Republican Luminary Joins Scooter Store Legal Team
Marc Racicot, a former governor of Montana and friend of President George W. Bush, recently joined The Scooter Store, New Braunfels, Tex, to lead the company’s legal team. As chairman of the Republican National Committee from 2001 to 2004, Racicot was instrumental in Bush's successful reelection campaign. Prior to his Republican party post, Racicot was governor of Montana from 1993 to 2001, and acted as the state’s attorney general from 1989 to 1992.

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