Work Group’s Wheelchair Coverage Proposal Echoes Many HME Industry Demands

Baltimore

A federal panel’s proposals to help revamp Medicare’s wheelchair benefit spells out many actions the HME industry has pushed hard for in recent months, sources said.

In December, the Interagency Wheelchair Work Group proposed eliminating current Medicare policy language — stating that a beneficiary only qualifies for a wheelchair when “bed or chair confined” — and replacing it with criteria based on a person’s functional mobility, including consideration of physical and mental capabilities and home environment, among other factors.

Made up of physicians, clinicians, therapists and other professionals from across several federal agencies, the group has been working since June to draft new coverage guidance for wheelchairs based on comments from the clinician, consumer and provider communities.

According to the draft, several Work Group members also suggested that the “in the home” statute language, which requires Medicare only pay for DME used primarily in the home, hinders patient independence.

“This is very positive,” said Seth Johnson, director of government relations for Exeter, Pa.-based Pride Mobility Products. “It’s exactly what the industry has been calling for,” he added, noting that the draft’s language may be partially due to a report attached to Congress’ omnibus spending bill, passed late last year. That legislation, which funds several federal agencies, calls for Medicare to consider a wheelchair user’s mobility needs to perform acts of daily living.

After reviewing the Work Group’s proposal, CMS concluded it should re-examine its own policies by taking the panel’s document through the National Coverage Determination (NCD) process, the agency said.

“Our goal is to focus on a set of clinical and functional characteristics that are evidence-based and will better predict who would benefit from a power wheelchair or scooter,” said Sean Tunis, chief medical director for CMS.

While industry advocates have interpreted this as a positive move, they also have said the NCD process will stall needed changes that have already been delayed.

“The report has great language, [but] there’s a timing and procedural issue,” said Cara Bachenheimer, vice president of government affairs for Elyria, Ohio-based Invacare. “All [CMS] did was announce the initiation of the [NCD] process. This is going to string it out throughout 2005.”

The agency has projected it will issue an NCD by Sept. 12.