Complex rehab: Leverage scientific evidence

Q. What efforts have been made to obtain coverage for power standing? 

A. Improving access to technology aimed at improving the lives of people living with physical disabilities has been an important mantra for the complex rehab industry for years. It is a sincere mantra, and one that many people have devoted time and energy to.  

Historically, efforts to improve access involved uniting stakeholders, gathering case examples demonstrating how current policies were inadequate, identifying congressional supporters, and educating policy makers. Recently, reviewing and compiling relevant published evidence has been added to the list of activities, and is proving to be a critical key to positive change.  

In 2020, ITEM Coalition submitted a formal request for reconsideration to CMS of Medicare’s non-coverage policy regarding power seat elevation and power standing features for use on Group 3 and above power wheelchairs. The initiative included the traditional strategies and tactics, and while each tactic proved important, there was one critical addition: published scientific evidence.  

Members of the Clinician Task Force formed a committee of clinicians to complete a systematic review of the published evidence related to power seat elevation and power standing. Their work provided a compilation of scientific evidence which was submitted with the ITEM request for reconsideration. The evidence was a critical component of the request. The outcome was a positive change in Medicare’s coverage policy for power seat elevation.  

The request for reconsideration submitted in 2020 included power standing. CMS divided the request into two reviews, however, and the power standing review has not been posted, and it is difficult to determine the timing.  

Advocates are hoping the roadmap to success will hold true for power standing. Advocates have increased their understanding of what is necessary to improve access to technology. CMS has demonstrated a willingness to cover technology when evidence shows medical and functional benefits. Now, if we can improve coding and payment policies, improving the lives of people living with physical disabilities will be achievable. 

Rita Stanley is principal and policy consultant at Merriman Innovation Consulting. Reach her at rita.stanley@merrimaninnovation.com.