CMS begins review of wheelchair coverage criteria

Sunday, December 19, 2004

December 20, 2004

WASHINGTON -  CMS last week announced the opening of a National Coverage Determination to review its criteria for wheelchair coverage under Medicare.
The NCD came as a surprise to some in the industry who were anticipating the announcement of a coverage proposal based on the recommendations of the Interagency Wheelchair Workgroup, a group comprised of physicians, therapists, researches and policy experts from HHS, the VA and the Department of Education.
“We thought the Interagency Workgroup’s job was to develop draft policy,” said Cara Bachenheimer, Invacare’s vice president of government relations.
Instead, the NCD will use the Workgroup’s report as further guidance in formulating its coverage proposal.
“When you look at the substance of the interagency report, it is great,” said Bachenheimer. “It recommends using a functional ambulation standard, assessing beneficiaries by defined criteria, and has specific instructions -  all the things that could be used as a national coverage criteria.”
The Interagency Workgroup was first expected to define the controversial “bed-or-chair-confined” criteria that had re-emerged in coverage decisions in the past year. Instead, recommendations from clinicians groups moved the focus more toward a functional-based determination of a beneficiary’s eligibility for power mobility.
Wording in the recent Congressional appropriations bill also encouraged CMS to abandon bed-or-chair-confined in favor of a functional definition.
“Our goal is to focus on a set of clinical and functional characteristics that are evidenced-based and will better predict who would benefit from a power wheelchair or scooter,” said Sean Tunis, CMS’s chief medical officer, in the announcement.
Under the NCD, CMS has an additional six months to draft its coverage proposal. That announcement will be followed by 30 days for public comment before a final decision is announced. Bachenheimer said she does not expect a final ruling until September.
“CMS seems to be moving more cautiously than we had anticipated,” said Bachenheimer.