Thursday, September 30, 2004

Clarification is on the horizon
with Seth Johnson

Q. Will CMS clarify the coverage criteria for power wheelchairs?

A. In June, CMS established an inter-agency work group comprised of CMS, HHS, the Veterans Administration and Department of Education for the sole purpose of developing clinical coverage guidance for power wheelchairs. The group began meeting in late July with the goal of releasing draft coverage guidance in mid-October and holding an Open Door meeting in November to receive public comments. The final coverage guidance is currently scheduled to be released by the end of this year.

The one common theme that the physicians, clinicians, consumer groups, suppliers and manufacturers all agree is for the need to have a functionally based standard of what constitutes non-ambulatory. The most common example provided to the work group is the Pennsylvania State Medicaid definition of “unable to ambulate.” This definition clearly states that an individual is non-ambulatory if they are unable to walk necessary distances safely, independently and within a reasonable amount of time.

The inter-agency work group is developing coverage guidance and the end result should be a more functionally based coverage criteria for power mobility products. This is a great opportunity to provide input into the development of clear coverage criteria and it is important that we continue to do so. The e-mail address for members of the work group is: wheelchaircoverage@cms.hhs.gov. This is truly a unique time for the rehab and assistive technology industry. Once this opportunity passes the industry will likely be operating under the new coverage guidance for a long time.

Seth Johnson is director of government affairs at Pride Mobility Products. He can be reached at 800-800-8586.