Stakeholders ramp up advocacy for standing wheelchairs

Thursday, July 28, 2011

LEBANON, Tenn. - Determined industry stakeholders continue to work to convince Medicare that standing equipment is medically necessary for some patients.

Stakeholders have long argued that standers and standing wheelchairs have medical benefits for patients. Currently, however, Medicare denies payment for the equipment, saying it's not medically necessary.

"It's not reasonable to say, across the board, that it's not medically necessary," said Jennifer Finger, in-house counsel for Permobil, a Lebanon, Tenn.-based manufacturer of standing wheelchairs. "You should do an individual assessment for each person."

Benefits of standing equipment can include improved bone density, digestion and circulation, and reduced swelling, Finger said.

Permobil's efforts to challenge Medicare's policy received a setback in June. That's when an appeals board upheld an administrative law judge's decision not to rule on the medical necessity of standing wheelchairs because, while they're mentioned in a policy article, they're not included in a local coverage determination.

Undeterred, Permobil will continue its efforts. It's currently examining options, Finger says.

A recent boost to efforts: NCART has formed a new Standing Workgroup comprised of manufacturers, clinicians, attorneys and providers to work on expanding coverage for standing equipment.

"This way, it's not one manufacturer that's trying to get it covered," said Don Clayback, NCART executive director. "It's not a particular supplier or even a group of consumers. It's really a voice that says, 'Look, there's well-established documentation that supports the coverage of these, and, in fact, many of your peers, from a payer perspective, are covering these, so this is something that you should also cover.'"

One of the workgroup's first orders of business has been to conduct surveys to find out where coverage for standing equipment is in place and where it is needed. The group will summarize that data and use it to convince payers to cover the equipment.