Contact:
Lynn Gonzales
Media Relations
The SCOOTER Store
(830)626-4064
The Power Mobility Rule: Congressional Intent & Clarifying Documentation Recommendations
On October 25, the Centers for Medicare & Medicaid Services (CMS) implemented its Interim Final Rule: Conditions for Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles despite Congressional concern about the negative impact the rule would have on Medicare beneficiaries. Additionally, members were equally concerned that CMS did not consider input from industry while developing this rule.
In December, Congress passed language in the 2005 Labor HHS Appropriations Bill that precludes the Department of Health and Human Services from using any funds to implement or enforce its Interim Final Rule. Congress intended, as stated in the joint explanatory statement, that CMS propose a new rule, allowing for public comment and a transition period. The SCOOTER Store is eager to work with CMS on the development of a new rule and offers the following recommendations towards ensuring that only those qualified Medicare beneficiaries receive power mobility equipment while creating certainty and clarity in the documentation process.
Recommendations on Amending the IFR:
We recommend that CMS amend section 410.38(c) (2) (iii) to include the following language:
"The treating practitioner, when prescribing a power mobility device (PMD), must complete a 'seven element prescription' and answers the following questions based on the face-to-face examination of the PMD patient, which together document medical necessity.
- Does the patient have mobility limitations? If yes, please explain.
- Does the mobility limitation interfere with the patient's ability to safely perform his/her activities of daily living (outlined in the NCD) including but not limited to toileting, feeding, grooming, or cooking?
- Can a cane or walker meet the patient's mobility needs inside their home? If no, please explain.
- Would a manual wheelchair meet the patient's mobility needs in the home? If no, please explain.
- Does the patient have the physical and mental capabilities to operate a PMD safely in the home?
- What has changed in the patient's physical or mental condition, home environment, or caregiver situation that now requires power mobility to perform their activities of daily living?
- If prescribing a power wheelchair, please explain why a POV (scooter) would not meet the patient's mobility needs inside their home.
Because the beneficiary has seen their treating practitioner specifically for the purpose of determining if and what level of Mobility Assistive Equipment (MAE) is medically necessary, the information gathered as a result of the examination should sufficiently document medical necessity. Suppliers should be responsible for gathering additional documentation from the treating practitioner to provide a clearer picture of the beneficiary's condition only if one or more of the following occur: the narrative response to a/the question(s) from the face-to-face examination is not answered by the physician/treating practitioner; and/or obvious contradictions to the physician's prescription and face to face examination exist in copies of the historical medical records that are provided to the supplier. Historic medical records that are 'silent' or ambiguous regarding mobility limitations should not be considered a contradiction."
Recommendations on Addressing Fraud and Abuse:
The SCOOTER Store recommends that CMS adopt the recently proposed Quality Standards and Third-Party Accreditation standards as soon as possible. This will address fraud and abuse by creating a newly defined minimum threshold requirement for suppliers to enter and participate in the Medicare program.
About The SCOOTER Store
Since 1991, The SCOOTER Store has helped provide freedom and independence to more than 350,000 people with limited mobility. The SCOOTER Store offers a full line of durable medical equipment, including power wheelchairs and scooters, lifts, ramps and accessories in all 48 contiguous states plus Puerto Rico. The SCOOTER Store has worked with more than 110,000 physicians, providing expertise and quality service to their patients, and is accredited by the Accreditation Commission for Health Care.
