CMS moves fast to address bed-or-chair-confined criteria

Monday, January 3, 2005

January 3, 2005

WASHINGTON - CMS has fast-tracked its efforts to develop new coverage criteria for wheelchairs and should have a final policy in place by mid to late March, Dr. Sean Tunis, CMS’s chief medical officer, told HME News last week.
CMS opened its National Coverage Determination Dec. 14, and under most circumstances the process to develop new coverage criteria, or leave it unchanged, takes 270 days. But with providers lobbying hard for a clarification of the current bed-or-chair confined coverage, CMS decided to speed up the process, Tunis said.
Last summer, Tunis head up the Interagency Wheelchair Workgroup. CMS charged the group with examining the existing wheelchair coverage criteria and recommending whether it should be changed or not. The group released the report last month.
In it, they recommend that CMS stop using the bed or chair confined criteria and adopt a more functional criteria, one that rests on whether a person can cook, bathe and safely carry out other mobility-related activities of daily living without the aid of a wheelchair.
The term bed- or chair-confined was never intended to be interpreted literally. Instead, Tunis said, the spirit of the term is what the Wheelchair Working Group came up with.
The group’s report will play a key role in how CMS rewrites or clarifies the current wheelchair criteria, as will public comment on the report.
“The challenge is trying to find some sort of reasonable dividing line between what makes a meaningful improvement in functional ability due to a medical condition, and what is a convenience that the large majority of people over the age of 65 might like at the end of a long day,” Tunis said.