Clinicians recommend a more functional Medicare policy for power wheelchairs

October 4, 2004 WASHINGTON - A group of the nation's leading occupational and physical therapy seating and wheeled mobility specialists have submitted recommendations to a Federal Interagency Wheelchair Work Group on how to establish “an objective and consistent process'' for determining a patient's medical necessity for powered mobility products, such as wheelchairs and scooters. Written by the Clinician Task Force of the Coalition to Modernize Medicare Coverage of Mobility Products (the Coalition), the 43-page document is designed to assist the CMS in devising a coverage policy that improves access to mobility products, while addressing government concerns about waste and abuse.  The document was prepared in response to a formal CMS request for clinical guidance concerning the revamping of the Wheeled Mobility Coverage Policy, part of their campaign to control for waste and abuse within the system. CMS commissioned the Interagency Wheelchair Work Group, comprised of federal employees, to oversee the revision process and consider external clinical guidance during their deliberations.   Laura Cohen, PhD, PT, ATP, and a co-Coordinator of the Clinician Task Force, said the core concepts of the recommendations are basic.  “They rely on a knowledgeable and trained clinician performing face-to-face evaluations of a patient's functional abilities and needs,'' she said. “The comprehensiveness of the evaluation and the clinical professionals required depends on each patient's medical needs.'' The recommendations create a foundation for developing new Medicare coverage guidelines for wheeled devices.  They are based on the key principles, standards and procedures used in wheeled mobility device service provision; developed using objective, evidence-based, professionally sound recommendations. The document developed and submitted to CMS includes five sections. The first two sections contain new concepts identifying a key measure or standard for determining medical need for wheeled mobility devices - functional ambulation and proposed coverage and payment rules that include a functional classification system. The third section outlines the requirements for a face-to-face clinical assessmentby askilled knowledgeable professional. The clinical assessment process outlines seven assessment topics related to the individual, environment and technology that is necessary to match the person to the technology. The fourth section describes the roles and responsibilities of the professionals involved in the process and the fifth section outlines a listing of coalition members, summary of coalition activities and intended next steps. The Coalition is interested in providing further assistance and guidance to CMS as the Interagency Wheelchair Work Group continues deliberations to revamp wheeled mobility device coverage policy. The Clinician Task Force has made an executive summary available that can be downloaded via the internet at www.cliniciantaskforce.com .  “Our recommendation is that functional ambulation should be the standard for wheeled mobility devices,” said Barbara Crane, PhD, PT, ATP, also a co-coordinator of the Clinician Task Force. “And functional ambulation should be measured by the patient's ability to meet the mobility needs arising during the course of typical daily activities.'' Understanding that this would be a new approach for CMS, the clinicians define this concept with precision in the full document. The Coalition was formed this summer after it became clear to clinicians, as well as advocates for the disabled, that CMS had adopted a conservative interpretation of the coverage guidelines for mobility devices. The new interpretation has had a major impact, causing Medicare claims that were once being approved to now be rejected.  Concerned that patients with legitimate needs were no longer getting the equipment they needed to move around within their residences, and in their communities, clinicians joined with organizations representing Americans with disabilities, credentialed suppliers and service providers to form the Coalition. The Clinician Task Force will continue to offer recommendations to CMS and the Interagency Wheelchair Work Group. “The members of the Coalition hope that our recommendations create a foundation for discussion with the CMS Interagency Wheelchair Work Group and we would like to participate further in developing the coverage policy,'' said Crane.  “It is important that the right equipment gets to the right people - those who need it to meet the mobility needs arising during the course of typical daily activities. The Medicare coverage policy needs to be revised for that to happen.'' Source: Clinician Task Force