CMS wheelchair forum draws hundreds

April 5, 2004 WASHINGTON - CMS officials spent two hours with providers, manufacturers and other industry types March 31 discussing Medicare's controversial bed- or chair-confined coverage criteria for wheelchairs. To the chagrin of many, however, the meeting didn't sufficiently clarify who is eligible for a Medicare-reimbursed wheelchair. Looking on the bright side, Pride Mobility President Dan Meuser noted that CMS “did give us a good amount of time.” The DMERC medical directors also indicated that under their local policies, wheelchair eligibility depends on whether a beneficiary is “usually totally non-ambulatory.” While that adds some coverage clarity, it is by no means enough, he said. “There is no question that we as an industry, as mobility care givers, are not satisfied with the outcome of the meeting or where we stand,” Meuser said. “There is too much room of misinterpretation.” Whether it takes “nine months or two years,” he added, CMS and the industry need to hammer out a definition of ambulation or non-ambulation that can be used for the majority of claims. “I don't think the industry is asking for 100% certainty - that will never happen,” said Cara Bachenheimer, Invacare's vice president of government affairs. “But the 80/20 rule probably applies. We could provide a whole lot more predictability, for the government, for the industry and for consumers.” The March 31 meeting came in response to industry uproar over the now infamous Dec. 9 DMERC “clarification” bulletin. That communication stated Medicare only pays for wheelchairs when a patient is bed or chair-confined. Prior to the clarification, CMS adhered to coverage criteria that granted eligibility to beneficiaries who required a wheelchair to maneuver safely around their homes, claim industry representatives. The emphasis on bed- or chair-confined is an illegal policy change spurred by a desire at CMS to rein in skyrocketing utilization, say industry representatives. Medicare's payments for wheelchairs increased from about $10 million in 1994 to more than $1.2 billion in 2003, said Kim Brandt, acting director of the CMS Program Integrity Group. She called that increase “significant.” More troubling, she added, is the 300% increase in spending for wheelchairs between 2001 and 2003. By comparison, Medicare's overall spending during that period increased only 11%, she said. Medicare officials attribute that increase to a number of  things: fraud, new technology, and also to a lax interpretation by the DMERCs of the bed- or chair-confined requirement. And estimated 630 people listened to the March 31 forum via telephone, and another 40 or so attended in person. Many fear that by declining to define bed- or chair-confined, providers will adhere to the strictest interpretation, denying access to beneficiaries who need a wheelchair but can walk a little. “CMS walked away (from the forum) with the realization that this issue isn't going way,” Bachenheimer said. “The repeated pleas from providers and consumers show that we need answers.”