Friday, April 30, 2004

ABCs of the CMN
With Tim Zipp
T. Zipp

Q. According to CMS, what does “bed or chair confined” mean?

A. While I agree with CMS that the coverage criteria for power wheelchairs has not changed since 1985, I do think that the definition of “bed or chair confined” changed with the revisions to the CMN in 1995-1996. In 1985 and today, the Coverage Issues Manual states that a wheelchair is covered “if the patient’s condition is such that without the use of a wheelchair he would otherwise be bed or chair confined.” However, in 1995-1996, HCFA and the DMERCS made formalized changes to the CMN with the input of several groups, including the Practicing Physicians Advisory Council; AMA; NAMES; HIDA; American Orthotics and Prosthetics Association; Council of Nursing Home Suppliers; American Society of Internal Medicine; and the Iowa State Medical Society.

Because of the confusion surrounding what was meant by the fourth question on the previous CMS/OMB approved CMN (“is the patient bed or chair confined”), the CMN was changed in 1996 to reflect a patient’s need for a wheelchair to move about inside the home. This indicated an interpretation by CMS and the DMERCs recognizing that the criteria applied to beneficiaries who needed wheelchair for movement to get around their home. The agency took the opportunity to revise questions on the CMN so that it would be clearer and have a more educational value for the physicians.

With CMS now stating that it is going back to the 1985 coverage criteria for power wheelchairs, it leaves the question for beneficiaries and suppliers to ask: Why are we ignoring the work of this authoritative group who undertook this difficult project to “clarify” what bed or chair confined means?

Tim Zipp is executive v.p. for government relations at The Scooter Store. For comment, e-mail him at tzipp@thescooterstore.com.