Power Wheelchair Criticized

On February 5,2005, the Centers for Medicare & Medicaid Services (CMS) released a draft on criteria for power wheelchairs and scooters coverage. These criteria will rely on clinical guidance for determining need. The new analysis begins with an assessment if the beneficiary has a mobility limitation preventing him/her from performing one or more mobility-related activities, like household chores at home.
This evaluation also considers if the use of assistive device – whether a simple cane or a sophisticated power wheelchair or anything in between would improve the beneficiary’s ability to function within the home. Taking into account visual or mental impairment, the criteria further evaluates what would affect the beneficiary’s ability to use the mobility equipment (power wheelchair) effectively.
According to the CMS Chief Medical Officer Sean Tunis, M.D., the draft of coverage criteria was intended to provide a clear and consistent guidance to Medicare contractors and clinician. This guide will ensure that beneficiaries receive the type of mobility device that will provide clinical benefits. Tunis was the one who spearheaded the agency’s move to a more functional assessment of mobility needs.
CMS also released new codes to ensure proper payment. These plans were outlined in the Modern Mobility Initiative announced last April. They are also launching new billing codes for power wheelchairs and scooters to ensure that Medicare pays appropriately for these devices.
The final NCD is planned to be published in March to provide guidance on how to use and document the new criteria.
However, these efforts of the CMS were criticized by the Medicare Rights Center, saying that the new wheelchair coverage policy does not provide mobility and independence for disabled and impaired people. The new approach of Medicare’s proposed coverage criteria would replace an older, more rigid standard that relied on whether a patient was “non-ambulatory” or “bed or chair confined”. The new proposed criteria would rely on clinical guidance for evaluating whether a beneficiary needs a device to assist for mobility, and if so, what type of device is needed.
According to the Medicare Rights Center president, Robert Hayes, CMS remains old fashioned in its ways and becomes more so by proposing to retain inhumane coverage policy that leaves people with disabilities isolated in their homes and from their communities. In his heavy criticism of the proposed coverage criteria, Hayes repelled the practice of Medicare as a continuing affront to the policies of Presidents George H.W. Bush and George W. Bush who, respectively championed the Americans with Disabilities Act and the New Freedom Initiative. Unlike the CMS policy, Hayes said that the two presidents’ steps were aimed at liberating people with disabilities from isolation and dependence.
Even as they criticized the criteria being proposed, Hayes acknowledged that they applaud some aspects of it including the function-based determination of medical necessity and the effort to develop new codes for paying wheelchair suppliers. Still, they are demanding that the White House review the new policy especially those that breed on isolation and dependence. -30-