OT Role with PMD Supported in CMS Final Rule
The Centers for Medicare & Medicaid Services (CMS) agreed with AOTA's comments on the Power Mobility Devices interim final rule that occupational therapists (OTs) can play an integral role in the patient evaluation. CMS published a final rule governing power wheelchairs and power-operated vehicles (collectively called Power Mobility Devices [PMD]) in the April 5, 2006 Federal Register.
The final rule implements statutory provisions that require physicians or treating practitioners (defined as physician assistants, nurse practitioners, or clinical nurse specialists) to conduct a face-to-face examination of the patient for a Power Mobility Device (PMD) before the device can be prescribed. The rule also eliminates the need for a certificate of medical necessity (CMN) because the CMN was viewed as providing insufficient documentation to determine medical necessity. The rule requires that the physician or treating practitioner send to the DMEPOS supplier pertinent portions of the medical record within 45 days after the face-to-face examination to support the prescription. The 45-day requirement represents a lengthening of the 30-day requirement proposed by CMS in the interim final rule.
By specifically acknowledging that OT and PT expertise can be an important contribution in certain PMD contexts, CMS validated the role of OTs in patient PMD evaluations. In fact, CMS points out that the Durable Medical Equipment Regional Contractors (DMERCs) have published an article detailing the way to integrate OT and PT services into the evaluation process, stating that "[a] PT/OT can file a claim for payment for their evaluation services, provided that all other applicable payment conditions are met." In addition, the rule states that an OT or PT consultation report can be submitted by the physician or treating practitioner as part of the medical necessity documentation to support the decision to prescribe a PMD.
CMS does not address in this rule the Assistive Technology Practitioner (ATP) certification requirement under the draft local coverage determination (LCD) on Power Mobility Devices published by the DMERCs. CMS states it is outside the scope of this regulation. The draft LCD proposed to permit only RESNA-certified ATPs to conduct comprehensive evaluations of Medicare beneficiaries needing tilt and other high end power chairs. Consequently, CMS leaves the ATP certification requirement issue in the hands of the local DMERCs to address in the final LCD. AOTA submitted comments to both CMS and the DMERCs in opposition to the ATP certification requirement in October and November 2005, respectively. A final LCD is expected to be published in the near future.
The final rule governing PMDs goes into effect on June 5, 2006.