‘In the home’ takes center stage

Saturday, July 31, 2004

WASHINGTON - Clinicians, the industry and many in disability groups urged CMS in June to consider revising wheelchair coverage requirements they say “tie their hands” when trying to treat beneficiaries.

The contentious “in the home” and “bed or chair confined” requirements for power wheelchair coverage took center stage during a four-hour special open door forum on CMS’s effort to revise the clinical coverage criteria for power wheelchairs and scooters.

“The [in the home] policy ties my hands and makes my recommendation of clinical necessity or what I believe to be clinically necessary invalid,” said Dr. Michael Boninger, medical director of the University of Pittsburgh’s Center for Assistive Technology.

CMS’s hands are also tied on this issue, according to chief medical officer Dr. Sean Tunis. He said the agency is reluctant to tackle this issue because it is statutorily beholden to the “in the home” restriction.

“While [Dr. Tunis] recognizes the need to make some modifications in that area, they are statutorily confined to work with the confines of the law, and that’s what they are doing,” said Seth Johnson, Pride Mobility’s vice president of government affairs. “Changing bed or chair confined, or in the home, CMS believes is a much more lengthy process.”

CMS’s timeline for producing the new coverage policy puts a December 31 deadline for a final policy release. A draft is expected by October 15.

A17 member Interagency Wheelchair Working Group has been installed to revise the policy. The group will be chaired by Tunis and includes nine officials from CMS and the Department of Health and Human Services, as well as doctors and PT/OTs from the NIH, VA and Department of Education. The Work Group was to convene for the first time last month.