Attempt to Clarify Interim Rule Only “Disheartens”
CMS hosted a Special Open Door Forum on the recently published interim final rule (see adjacent article) regarding “Medicare Conditions for Payment of Power Wheelchairs and Power-Operated Vehicles” on September 13, 2005. “The one thing all stakeholders agreed on is support for delaying implementation until April 2006,” says Seth Johnson, director of government affairs for Pride Mobility Products Corp, Exeter, Pa, and chairman of the AAHomecare RATC. “How can CMS possibly move forward with implementation of these new procedures when they readily admit that there are significant missing pieces that will not be finalized until late this year?”

After the forum, CMS issued refinements to the HCPCS codes (in the form of a draft local coverage determination [LCD]), performance standards, and testing requirements for power mobility devices to become effective January 1, 2006. “These refinements represent a whole new coding system complete with new testing protocols and code categories. It is disheartening that CMS has changed the one thing in the PMD equation that the industry thought was set back in February,” says Johnson. “The previous testing standards and codes finalized in February of this year required extensive time and money to comply by the September 1 CMS-imposed deadline for submitting new code applications. Now CMS has changed the entire equation again, which will require even more resources.”

According to CMS, the new code set was created to address policy and pricing difficulties experienced with the existing power mobility codes. The announcement stated: “Part of these new code sets included testing standards and required manufacturers to have their products tested and the results submitted to the SADMERC for a determination as to which code to place their power mobility devices.”

CMS and the SADMERC instituted the following changes to the code sets and testing requirements by:

• adding a new “standard use” category for power mobility devices;
• revising characteristics of the previous categories of power mobility devices;
• revising testing requirements for all categories of power mobility devices to be consistent with RESNA standards;
• establishing a testing strategy that will allow consistently assigned power wheelchairs to specific codes;
• revising testing requirements so the agency is able to differentiate among the various levels of equipment in terms of durability and level of performance; and
• extending testing period to November 15, 2005, for all products not already tested or that have failed testing.

The DMERCs posted their Local Coverage Determination (LCD) and Policy Article for Power Mobility Devices for comment starting on September 14, 2005. Comments to each DMERC medical director must be submitted no later than October 31, 2005. “The LCD was intended to provide the industry with a clear road map of the rules to follow under the new coverage policy,” says Johnson. “Unfortunately, the LCD raises additional issues that must be clarified prior to implementation. One concern is that the LCD does not differentiate in the coverage criteria for Standard Use, Standard Plus, and General Use. This must be clarified to ensure Medicare beneficiaries have access to the most appropriate technology to address their mobility needs. The one good thing about the LCD is there is a 45-day comment period.”

“AAHomecare appreciates the opportunities it has had to dialogue with CMS during the development of these policies,” adds Kay Cox, president and CEO of AAHomecare. “While some progress has been made, the interim final rule represents a significant departure from previous policy, and its impact on the industry should not be underestimated. With the addition of the LCD and HCPCS coding refinements, AAHomecare feels even more strongly that a delay in implementation until April 2006 is necessary to ensure that beneficiary access to PMDs is not jeopardized and the transition is smooth.”

NCART Launches Medicaid Initiative
The National Coalition for Assistive and Rehab Technology (NCART) has introduced a new initiative to ensure that Medicaid recipients have access to rehab and assistive technology products and services. The initiative focuses on securing appropriate funding for seating and wheeled mobility products. To ensure prompt and effective relief, NCART will be employing regulatory and legislative efforts and will reach out to stakeholders, state associations, key rehab suppliers, consumer advocates, and clinical groups to form strong alliances.

Rita Hostak

As part of the initiative, Matthew Burke has agreed to join NCART as Medicaid project director. “We believe Matt’s experience in the DME industry, as chair of the RATC, and as a Board member of NEMED prepares him well to work on state Medicaid issues affecting the rehab industry,” says Rita Hostak, president of NCART and vice president of government relations for Sunrise Medical, Longmont, Colo. “Adequate and timely reimbursement from state Medicaid programs is critical to rehab technology companies, and without it, consumers lose access to medically needed products and services. Medicaid cuts are threatening the rehab industry, and NCART is committed to bringing stability to this important group of suppliers.”

HME Licensure Hits Indiana in AIHMES Victory
In May of this year, the state of Indiana passed SB 206 establishing the requirement that HME companies serving the people of that state must be licensed as of July 1, 2006. The Association of Indiana Home Medical Equipment Services (AIHMES) backed the bill and Indiana State Senator Gary “Doc” Dillon, a practicing physician, sponsored it in the state legislature. The licensure process will be under the authority of the Indiana Board of Pharmacy. The bill passed the House 98 to 2 and the Senate 47 to 0. The licensure legislation requires all companies involved with the renting of HME and the selling of rehabilitation equipment to be licensed.

A subcommittee was appointed to work with the Board of Pharmacy to establish the rules under which the law will be enforced and to draft an application form. The draft of the rules is being published in the State register and a hearing date for the proposed rules has been set for November 14, 2005, at 9:30 AM (room W064) of the Indiana Government Center South in Indian-

apolis. It is anticipated that applications will go out before the end of the year, and inspections will start shortly thereafter. All providers will be inspected prior to being issued a license, and this process is expected to be done well ahead of the July 1, 2006, deadline.

A complete list of services requiring licensure is listed on the AIHMES Web site (www.aihmes.org) along with drafts of the rules and an application form. Any questions concerning licensure requirements can be directed to Todd Stallings, executive director of AIHMES, at (317) 844-6643 or George Kucka, immediate past president of AIHMES, at (219) 742-5598.

Hurricane Katrina Response
In the aftermath of Hurricane Katrina, we at Home Health Care Dealer/Provider continue to receive news of the home care community’s generous response. Dealer/Provider editorial advisory board member Mike Hamilton, head of the Alabama DME Association, is encouraging members to make donations to the American Red Cross and the Salvation Army. AAHomecare has a toll-free number (866-289-0492) for members of the home care community in need of assistance, and www.aahomecare.org   is also an excellent resource. On October 18 at Medtrade Atlanta, AAHomecare will host a Humanitarian Dinner to honor and raise money for Hurricane Katrina relief.