Clinician coalition calls PWC eligibility outdated

Thursday, September 30, 2004

WASHINGTON - A coalition of respected rehab clinicians has joined the industry’s effort to convince CMS that a strict interpretation of its bed- or chair-confined eligibility criteria denies wheelchairs to needy beneficiaries.

The Coalition to Modernize Medical Coverage of Mobility Products announced in August that it will submit clinical guidance to a government task force charged with evaluating the need to change Medicare’s coverage policy.

“We realize that many people who have legitimate needs for wheeled mobility devices are not getting access to them,” said coalition co-coordinator Laura Cohen.

The bed- or chair-confined criteria, which Medicare began to enforce strictly in December, was written years ago and is “truly outdated and not consistent with standard practice today because the technology wasn’t available then,” she added.

Cohen currently performs clinical research at the Shepherd Center, a catastrophic care hospital in Atlanta that specializes in spinal chord and brain injuries. She holds a Ph.D. in rehab science and technology.

The coalition includes 30 rehab clinicians from around the country. If these clinicians and others provided wheelchairs only to bed- or chair-confined Medicare beneficiaries they’d “be put in jail for malpractice,” said coalition member Mark Schmeler, director of the Center for Assistive Technology at the University of Pittsburgh Medical Center.

“We don’t practice as therapists that way,” Schmeler said. “We get people out and active in their community and doing what they want to do.”

In fact, Schmeler added, no other medical or rehab treatment exists with the level of restriction CMS has applied to power wheelchairs.

“If you came to me because you had a knee or hip replacement, I can’t say, ‘You can walk good enough to get between your refrigerator, bathroom and couch. You don’t qualify anymore for therapy,’” he said.

Among other things, the coalition will provide the Interagency Wheelchair Work Group with guidance on defining “functional ambulation” or what level of mobility device a person needs to perform his “typical daily activity” in and outside the house.

“If you have the proper equipment, you have the ability perhaps to live independently versus having to live in an institution or having a lot of extra care that would be covered by Medicare,” Cohen said. “There is a functional need that needs to be established.”

The inter-agency task force examining Medicare’s coverage criteria for power wheelchairs includes 19 people from HHS, the VA, the NIH and the Department of Education. It’s scheduled to deliver a first draft of the criteria by mid October and a final draft by year’s end.