"In the home" takes center stage at open door forum

Sunday, June 20, 2004

June 21, 2004

WASHINGTON - Clinicians, the industry and many disability groups urged CMS last Monday to consider revising wheelchair coverage requirements that "tie their hands" when trying to treat beneficiaries.
The contentious "in the home" and "bed or chair confined" requirements for power wheelchair coverage took center stage during a four-hour special open door forum on CMS's effort to revise the clinical coverage requirements for power wheelchairs and scooters.
"The [in the home] policy ties my hands and makes my recommendation of clinical necessity or what I believe to be clinically necessary invalid," said Dr. Michael Boninger, medical director of the University of Pittsburgh's Center for Assistive Technology.
CMS's hands are also tied on this issue, according to chief medical officer Dr. Sean Tunis. He said the agency is reluctant to tackle this issue because it is statutorily beholden to the "in the home" restriction.
"While [Dr. Tunis] recognizes the need to make some modifications in that area, they are statutorily confined to work within the law, and that's what they are doing," said Pride Mobility's vice president of government affairs. "Changing bed or chair confined, or in the home, CMS believes is a much more lengthy process."
CMS's timeline for producing the new coverage policy puts a December 31 deadline for a final policy release. A draft is expected by mid-October.
A17 member Interagency Wheelchair Working Group has been installed to revise the policy. The group will be chaired by Tunis and includes nine officials from CMS and the Department of Health and Human Services, as well as doctors and physical and occupation therapists from the NIH, VA and Department of Education. The workgroup will convene for the first time at a yet-to-be-determined date in July.