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THE DEPARTMENT OF HEALTH AND HUMAN SERVICES IS SEVERELY RESTRICTING ELIGIBILITY FOR POWER WHEELCHAIRS. On September 9, 2003 the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG) at the Department of Health and Human Services announced an initiative to curtail the growth of Medicare payments for power wheelchairs. As part of this initiative, CMS and its Durable Medical Equipment Regional Carriers (DMERCs) issued "clarifying" bulletins that unfairly and significantly limit patient access to wheeled mobility and apply these new standards retroactively.
Prior to the new bulletins, national and local medical review policies allowed coverage and reimbursement for power wheelchairs for patients who are bed or chair confined, who have a condition that renders a wheelchair medically necessary for use in their homes, and who are unable to operate a manual wheelchair.
DMERCs interpreted these requirements fairly to provide wheelchairs if patients needed them to perform activities of daily living within the confines of the home. DMERCs accounted for cardiopulmonary and other neurological conditions that do not necessitate actual bed or chair confinement by allowing patients with these diseases who lack the functional ability to ambulate to qualify for wheeled mobility.
The DMERCs have since rescinded this new, restrictive policy in March 2004. However, due to a failure by CMS to issue a clear, consistent coverage standard, patients continue to be denied access to medically necessary mobility equipment.
CURRENT POLICY CONTINUES TO PENALIZE ANY PATIENT WHO CAN TAKE MORE THAN ONE STEP EVEN WITH THE ASSISTANCE OF A CANE, CRUTCH, OR WALKER.
Under the current policy, any patient who can take more than one step, even with the assistance of a cane, crutch, or walker, to transfer from a bed to a chair may be considered "ambulatory" and therefore would not qualify for a manual wheelchair.
Any patient who has a condition other than muscular or neurological weakness in the upper extremities will not qualify for a power wheelchair including: patients with cardiopulmonary disease whose limbs allow them to walk but whose lives would be at risk if they do, may no longer qualify for power wheelchairs. Patients with progressive neurological diseases with waxing and waning symptoms, such as multiple sclerosis and ALS, will also be denied wheeled mobility until they become 100% bed or chair confined.
Because of this policy, all of these patients may be faced with moving to nursing homes or assisted living facilities prematurely, relying completely on caregivers to accomplish activities of daily living, and possibly incurring fractures through falls.
THIS POLICY DOES NOTHING TO PREVENT FRAUD; IT ONLY HARMS INNOCENT BENEFICIARIES WHO NEED POWER WHEELCHAIRS TO MAINTAIN THEIR INDEPENDENCE AND QUALITY OF LIFE. |
