Sen. Grassley asks CMS to explain PWC coverage

Sunday, February 29, 2004

March 1, 2004

WASHINGTON - Sen. Charles Grassley, R-Iowa, chairman of the powerful Senate Finance Committee, asked CMS last week to explain how it developed a December coverage clarification that limits power wheelchairs to beneficiaries who are bed- or chair-confined.

"While ensuring that we do all that we can to eliminate fraud and waste from government programs," Sen. Grassley wrote in a letter to CMS, "I also want to be certain that we are not inappropriately preventing our eligible citizens from obtaining the medically-needed equipment they are authorized to receive."

Prior to issuing the clarification, the DMERCs adhered to coverage criteria that rested on whether or not a beneficiary required a power wheelchair to maneuver around his home, say rehab providers.

Medicare officials say that enforcing the bed- or chair-confined criteria standardizes power wheelchair coverage among the four DMERCs. Tim Hill, CMS’s chief financial officer, described the effort as not so much new policy, as the industry claims, but as "new scrutiny" by officials who had grown lax in monitoring regulations in place since 1997.

In his letter, Grassley noted that representatives of the DME and disabled communities have raised questions about the definitions of ambulatory, nonambulatory, walking, upper extremity weakness and within the home.

Bryan Dylewski, CEO of Mobility Products Unlimited, Holly Hill, Fla., said that Sen. Grassley has cited the core problem.

"In its haste to fight fraud, CMS is needlessly hurting citizens with disabilities who need motorized wheelchairs to function in their homes," he said. "Increased mobility is very important to citizens with disabilities, and this CMS policy change puts Medicare in the position of hurting people who very much need their help."

Organizations representing Americans with disabilities and an industry coalition, known as RAMP - the Restore Access to Mobility Partnership - have been urging the White House, Congress and the Department of Health and Human Services to persuade CMS to rescind the new policy.