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Power Wheelchair Industry Asks Clarification of New
Medicare Rules
Feb. 9, 2005 - A coalition of power wheelchair
manufacturers and suppliers today recognized the Centers for Medicare
and Medicaid Services (CMS) for its “timely development” of a new draft
coverage policy for power mobility equipment, but said several
provisions must be clarified before a formal policy is implemented.
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On Thursday, CMS proposed a coverage policy that
creates a more functional criteria for determining Medicare eligibility
for power wheelchairs, while eliminating the controversial “bed or chair
confined’’ standard, which claim processors have been strictly
interpreting for the past year, resulting in denied access to medically
necessary mobility equipment.
“We are pleased that the leadership team at CMS
has made resolving this issue a priority,’’ said Scott Meuser, Chairman
and CEO for Pride Mobility Products Corp. “The industry is reviewing
their proposal. There are some unresolved questions, but we see this as
a positive first step towards creating a national coverage policy that
will allow Medicare beneficiaries in need of power wheelchairs to obtain
them.’’
Further, Michael Hammes, Chairman and CEO of
Sunrise Medical, acknowledged that CMS had delivered, at least in part,
on what the industry, clinicians and consumer advocates had requested.
“Clearly, we are moving towards a coverage policy that takes into
account the functional needs of the Medicare beneficiary,’’ he said. “We
all want to go in that direction. Now, we just need to ensure that the
coverage proposal does not regress in any way, and raise any new
restrictions for Medicare beneficiaries with a medical need for power
wheelchairs.’’
Specifically, CMS determined that mobility
assistive equipment (MAE) is reasonable and necessary for beneficiaries
with disabilities that impair their ability to perform daily living
activities, such as toileting, feeding, dressing, grooming and bathing.
“Determination of the presence of a mobility
deficit will use an algorithmic process…to provide the appropriate MAE
to correct the mobility deficit,’’ according to the memorandum outlining
the proposal. “With this decision, CMS also proposes to delete the ‘bed
or chair confined’ criterion currently used to determine if a wheelchair
is reasonable and necessary.’’
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While the industry strongly supports eliminating the problematic bed or
chair confined standard, there are questions about how the new
eligibility criterion will be implemented and its impact on Medicare
beneficiaries. Some of the questions include:
The proposal establishes new functional criteria
for eligibility, such as using mobility equipment to perform daily
living activities. But the industry wants to ensure that this new
criteria does not eliminate mobility itself as a functional need.
Documentation. The draft proposal doesn’t spell out
what documentation will be required from suppliers and physicians to
demonstrate the medical necessity for the people seeking power
wheelchairs. This important issue needs to be clarified so that it is
not left to interpretation by the claim processors.
The proposal does not eliminate the “in the home’’
restriction which mandates that a power wheelchair must improve a
patient’s ability to function within the four walls of their home. The
industry, as well as clinicians and advocates for people with
disabilities, have urged CMS to remove this restriction because it is
often in the patient’s best interest to increase mobility outside the
home.
Moreover, Bryan Dylewski, CEO of Mobility Products
Unlimited, raised a pointed question about the proposal. “Is this a
change in policy or is this just new language?’’ he asked, noting that
the new language must not allow CMS to continue processing claims in the
same restrictive manner they have used for the last year.
Mr. Dylewski also focused on the documentation
issue. “For suppliers particularly, the documentation issue must also be
elaborated upon by CMS whether it is in the new coverage policy or some
other form,’’ he said. “There must be a process that can be easily
understood and implemented by suppliers and physicians. One of our
concerns is that the new coverage policy will sound good, but will
create confusion when it is put into practice.’’
Mal Mixon, Chairman and CEO of Invacare Corp., said
that the proposal will require a careful review by all the stakeholders.
“What we don’t want to do is have a new policy
that puts more people at risk of not being able to obtain a power
wheelchair,’’ he said. “I think CMS has good intentions. And we
appreciate their apparent acknowledgement that it was very important to
find a timely resolution to the coverage issues. But we will be closely
reviewing the proposal and in the coming days, RAMP will identify any
provisions that could potentially make the coverage policy more
restrictive. Senior citizens and people with disabilities deserve a
Medicare coverage policy that responds to their needs. The industry will
work with CMS to make sure that kind of policy is put in place.’’
Restore Access to Mobility
Partnership is a coalition representing power wheelchair providers and
manufacturers. Members include: the American Association for Homecare;
Invacare Corporation; the MED Group; Mobility Products Unlimited, LLC;
Pride Mobility; and Sunrise Medical.
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