Coalition fights to rescind k0011 coverage criteria

Sunday, February 1, 2004

February 2 , 2004

WASHINGTON - Leading HME manufacturers of power wheelchairs joined forces last week with a variety of senior and disability groups to lobby against criteria that could severely limit access to K0011 chairs.

Together, the national organizations and the industry coalition, known as RAMP – the Restore Access to Mobility Partnership – are calling on the White House, Congress and the Department of Health and Human Services to persuade CMS to rescind the new policy.

The Dec. 8 and Dec. 9 bulletins from all for DMERCs are widely viewed as a crackdown on the remarkable growth in Medicare expenditures for the K0011 and a reining in of a liberal interpretation of the “bed or chair confined” policy that governs medical necessity.

By limiting power wheelchairs only to those Medicare beneficiaries who are bed or chair confined, CMS denies access to those who can walk a few steps but by doing so risk falling. Or maybe they can walk multiple steps but can’t maneuver freely throughout their home, say industry watchers.

Rather than adhering strictly to the bed or chair confined criteria, a better guideline for medical necessity would rely on “functional ambulation.” That is, whether or not a beneficiary can ambulate safely around his home without a power wheelchair, say industry sources.

“We are going to work with groups representing people with disabilities, senior citizens, clinicians, physicians, consumers and others to put this important issue on the national agenda,’’ said Mal Mixon, Chairman and CEO of Invacare, a RAMP member. “Americans need to know that the administration has taken an action that is not in the best interest of their loved ones, whether they are family, neighbors or friends. This new policy creates a situation where millions of people whose quality of life could be vastly improved are denied a better existence.”

Until the DMERCs issued their December bulletins, the carriers interpreted the bed or chair confined criteria differently, some more liberally than others. Adhering to a strict interpretation, creates uniformity from region to region and simplifies the adjudication of claims by stating clearly who qualifies and who does not qualify for a power wheelchair, said Region D Medical Director Dr. Robert Hoover.

RAMPs members include the American Association of Homecare; Invacare; the MED Group; Mobility Products Unlimited; Pride Mobility; The Scooter Store; and Sunrise Medical.

Working with RAMP on this effort are organizations including Advancing Independence, AAPD, Paralyzed Veterans of America (PVA) and WID. All of these organizations are members of ITEM -- Independence Through Enhancement of Medicare and Medicaid -- a diverse coalition of over 70 disability, aging, consumer groups, labor and voluntary health associations.