Committee urges CMS to improve PWC access

Tuesday, August 31, 2004

WASHINGTON - The House Appropriations Committee on July 14 called on CMS to expand its definition of “nonambulatory” so that people who cannot perform basic acts of daily living will be eligible to receive a power wheelchair.

The surprisingly vigorous message was contained in report language that will accompany the Appropriations Committee’s Labor/HHS/Education legislation to a full House floor vote after the summer recess.

The committee wants CMS to develop coverage policy based on a functional standard of nonambulatory.

“The committee believes beneficiaries who cannot perform their basic acts of daily living, toileting, food preparation and emergency egress, are nonambulatory and must have access to this mobility benefit to function independently,” the committee wrote.

The language is not binding, and CMS is not obliged to implement the committee’s advice. But the message is indeed resounding, say the industry’s directors of government relations.

“When the committee that funds your agency tells you to do something, it sends a very strong signal,” said Seth Johnson, director of Pride Mobility Products’ government relations.

If the agency - in this case, CMS - fails to act upon such direction, the Appropriations Committee is likely to take a dimmer view of future requests by HHS administrators, said Johnson.

In the Senate, the industry is now working to get Sen. Arlen Specter, R-Pa., to include the same language in a bill produced by the Senate Appropriations Committee, where he is chairman.

The House language echoes an insistence by vendors and suppliers that CMS loosen its strict interpretation of bed or chair confined language to include a real-world appreciation of what it means to be nonambulatory.

“If there’s a fire, you’ve got to be able to get out of your house,” said Calvin Cole, director of corporate development at Hoveround. “If you can take those one or two steps, and so don’t qualify for a power wheelchair, well that’s a dangerous scenario.”

How this language affects the Interagency Wheelchair Work Group that’s been tasked with clarifying current coverage policy is unclear.