BALTIMORE--CMS' DME Program Safeguard Contractors have eliminated a requirement for a certified Assistive Technology Practitioner (ATP)--a credential bestowed by the Rehabilitation Engineering & Assistive Technology Society of North America--to evaluate beneficiaries receiving certain power wheelchairs.

Scheduled to take effect April 1, 2008, the requirement was included in the LCD for power mobility devices. But a bulletin published Wednesday said "after consideration of the issues, the PSCs have decided to remove this requirement from the policy."

Instead, the three medical directors for the PSCs said the current evaluation requirement would remain in place: Patients must have "a specialty evaluation that was performed by a licensed/certified medical professional, such as a PT or OT, or physician who has specific training and experience in rehabilitation wheelchair evaluations and that documents the medical necessity for the wheelchair and its special features."

The specialty evaluation applies to patients receiving a Group 2 single- or multiple-power option power wheelchair, any Group 3 or Group 4 PWC or a push-rim activated power assist device for a manual wheelchair.

The PSCs also will retain a requirement that the equipment come from a supplier employing a RESNA-certified Assistive Technology Supplier (ATS) "who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the patient."


The revision came in response to requests from the American Occupation Therapy Association, the American Physical Therapy Association and the American Association for Homecare to reconsider the LCD.

"Without such action, the independent ATP requirement would have ... caused significant access issues for patients" due to the "significant shortage of OTs and PTs with the ATP credential in many parts of the country," said Seth Johnson, vice president of government affairs for Exeter, Pa.-based Pride Mobility Products and a member of AAHomecare's Rehab and Assistive Technology Council.

"Our goal was simply to delay the implementation of the requirement to provide time for OTs and PTs to get that certification," he continued. "We do see the need for that credential. The way that the medical directors ultimately decided to address the shortage issue doesn't eliminate permanently the need for some type of independent certified therapist to have a role in the provision and the evaluation of the patient for this equipment."

Nothing precludes the medical directors from monitoring the situation and adding the requirement back to the LCD at a future date, Johnson said. "But as far as addressing the immediate need, everyone agrees this decision by the medical directors does accomplish that goal."

Although RESNA expanded its testing schedule for the ATP and ATS exams this year, the total number of people credentialed at the end of October was 2,812. Of those, 1,138 are ATSs and 1,674 are ATPs.


"This would have created a real access issue and a backlog for consumers, especially in rural areas," said Gary Gilbert, president of Chesapeake Rehab Equipment, Baltimore, and vice president of the National Coalition for Assistive and Rehab Technology. "Some will argue that this is a setback for controlling the quality of the evaluation and delivery process. I believe that the quality will be maintained by having certified suppliers--ATSs--and OTs and PTs who are proficient in seating and mobility involved in the process."

He added removing the ATP requirement "means that the current supplier-referral relationships will continue and there will not be severe dips in the revenue stream while we try and divert the referrals to those few clinics that employ ATPs."

"I think it's a good thing," said Don Clayback, vice president of government relations for The MED Group, Lubbock Texas. "The bottom line is this decision had to be made because there just weren't enough people to make it happen, and at the end of the day, the beneficiary is still protected. You still have to have a knowledgeable PT or OT involved in the process and a credentialed ATS on the supplier side.

"It's a step up from where things were," Clayback said. "The difficult thing both financially and time-wise is we do have therapists who sat for the exam. But that's a credential they can use, and it does distinguish them."

According to Tim Pederson, ATS, CEO of WestMed Rehab in Rapid City, S.D., and chair of AAHomeCare's RATC, the Council had asked that the ATP requirement be phased in over a three-year period to allow practitioners additional time to get certified.


The 200-question RESNA ATP exam costs $500.

"Now we are hearing that reimbursement is being reduced for the therapists who conduct wheelchair evaluations. It is highly unlikely that we would have an adequate number of ATPs no matter how long the requirement is phased in," Pederson said. "Therapists are unlikely to take the time and spend the money to test for the ATP credential because of the substantial reduction in reimbursement proposed by CMS for those therapists who do this work."

Indeed, not everyone is convinced removal of the ATP requirement is a good thing.

Simon Margolis, executive director of the National Registry of Rehabilitation Technology Suppliers--a registry of professionals with the RESNA credential--said he felt the complex rehab and assistive technology profession had been "sold out."

According to Margolis, a past president of RESNA, "the typical curriculum of a PT or OT school includes little or no training in this area."


"In general we're disappointed with the medical directors' decision," said Glenn Hedman, RESNA's current president and director of the Assistive Technology Unit at the University of Illinois, Chicago. "We did greatly expand our number of exam offerings in 2007, and that schedule continues into 2008. We felt very strongly that the professionals on both the ATP and ATS sides were responding to the regulation and showing strong interest in obtaining the credential.

"We have been in communication with the medical directors," Hedman continued, "and do hope that they revisit the requirement in the future, as we feel it does help identify qualified professionals to perform the power mobility evaluations." Hedman said the RESNA Professional Standards Board is currently considering development of another specialty credential in seating and mobility.

View the PSC bulletin.