New Power Wheelchair Guidance Expected by Year’s End

Washington

What are the thresholds clinicians use to determine who qualifies for power mobility equipment and who doesn’t?

That question was the subject of a special CMS Open Door Forum held in mid-June as part of the agency’s new three-pronged approach — including coverage, standards and coding — to restructuring Medicare’s power wheelchair benefit. At the forum, CMS introduced the Interagency Wheelchair Work Group, which, over the coming months, will create a framework for clinical coverage policy for power wheelchairs.

The government group is made up of clinical experts from across the Department of Health and Human Services, including the National Institutes of Health, along with physicians and physical and occupational therapists from the Department of Veterans Affairs and Department of Education. Sean Tunis, CMS’ chief medical officer and the work group’s leader, explained that to include non-federal employees would require the agency to work under the rules of the Federal Advisory Committee Act, which “would be very time-consuming.”

“The work group consists of federal representatives,” explained Richard Lawlor, director of CMS’ Open Door Initiative, “but through public comment we hope to draw widely from experts across the country.”

In a schedule outlined at the forum, the work group planned to hold its first meeting sometime this month. Public comments on the guidance are due Sept. 1, and a draft policy should be completed by Oct. 15. After another Open Door session in mid-November, CMS’ final policy on power wheelchair coverage is expected to be released by Dec. 31.

At the forum, work group members asked for input on how to structure the guidance, and which clinical elements should be incorporated into the wheelchair policy. Responding participants’ opinions varied. Some said the decision of who qualifies for a power wheelchair should be left to the doctor. “We shouldn’t try to determine [who qualifies] through diagnosis codes. It’s impossible,” said one wheelchair provider.

Peter Thomas, president of ITEM (Independence Through Enhancement of Medicare and Medicaid), recommended a system resembling Medicare coverage guidelines for prosthetics, which uses a series of levels based on patient functionality. “It works very well,” Thomas said. “It’s an analog that may help you [develop a process] to get the right mobility device into the hands of the right beneficiaries.” ITEM is a coalition of more than 70 consumer and provider groups.

Other participants commented on how a Medicare statute limits coverage to power mobility equipment used primarily in the home. “A functional definition [of non-ambulation] without a limitation of solely in-the-home use … is what’s needed,” stated one clinician.

In response, a CMS official said that such a definition would require “a statutory change and [would require] a lengthier process.” Not to take the issue off the table, the official commented, such a change should “not handcuff our efforts to try to provide greater clinical guidance and clarity” for power wheelchair coverage.

Interagency Wheelchair Work Group Timeline

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