CMS delays issuing new PWC coverage criteria

Sunday, April 17, 2005

BALTIMORE -- Industry watchers expected CMS to release a final draft of its new coverage criteria for power and manual wheelchairs in late March, but so far nothing has been issued.

The official word from CMS is that the new criteria is in "clearance". That means officials at CMS, Office of Management and Budget and Department of Health and Human Services are still reviewing the final changes. Before the new criteria can be released, all three agencies must sign off on it. When that will be, is anyone's guess, said a CMS official.

Restore Access to Mobility Partnership (RAMP), which represents the power wheelchair industry, said the extra time could be used to ensure that an adequate documentation system can be swiftly implemented to compliment the new coverage policy and to implement the recommendations made by clinicians, advocates for the people with disabilities and other stakeholders. The new coverage policy will establish guidelines for Medicare beneficiaries in need of power wheelchairs and other mobility equipment.

"We have been waiting for CMS to address issues that have collectively made it more difficult for Medicare beneficiaries to obtain power wheelchairs," said Bryan Dylewski, CEO of Mobility Products Unlimited. "We hope that the wait won't be much longer for the industry, but more importantly we want the new coverage policy to make wheelchairs available to Medicare beneficiaries who need them to increase their mobility. Those are the people who are being hurt most by this delay."

One of the key issues for the industry, as well as clinicians and advocates for the disabled, will be whether the new coverage policy will allow beneficiaries to use power wheelchairs outside of their homes. A common practice of the clinical community is to prescribe based on the need for mobility beyond the home and the policy needs to address this practice. Another issue is whether CMS will acknowledge that a beneficiary should be eligible for a power wheelchair if the equipment increases their mobility, regardless of whether the equipment increases the ability of the individual to perform daily living activities. Clinicians and patient groups fear that CMS might tie eligibility to the wheelchair improving a patient's ability to accomplish tasks such as grooming, toileting and preparing food, rather than recognizing that a patient should have the right to mobility for its own sake

In addition to new coverage criteria, industry leaders expect CMS to release shortly a revised CMN for wheelchairs; a final or interim rule on Medicare's new face-to-face requirement; and a revised rule on who can prescribe scooters.