N.Y. nixes prior approvals for manual wheelchairs

ALBANY, N.Y. - With a new governor in office, the state's Medicaid program offered an olive branch to rehab providers in July, eliminating the prior approval process for manual wheelchairs and accessories. Providers' reaction: It's a start, but it's not enough. Providers now use a dispensing validation system (DVS) to obtain approval for manual wheelchairs. The DVS, used already for other HME, allows providers to request and receive approval electronically. That's a far cry from submitting and receiving prior approvals through the mail, a process that delayed payment and access, they say. Medicaid held more than half a dozen seminars for providers, clinicians and beneficiaries in August to spread the word about the change and address any further concerns. "The motto of the new regime is 'Patient First,'" said Carol Napierski, executive director of the New York Medical Equipment Providers (NYMEP) association. "We may be seeing a turn in the path." Providers have struggled with prior approvals for wheelchairs, especially custom wheelchairs, for years. The struggle climaxed last year, when a group of state legislators released a report stating some providers waited up to a year for approval for custom wheelchairs. Custom wheelchairs still require prior approval. That's still a problem, industry sources said. Bill Tobia, owner of Home Medical Equipment in Garden City, N.Y., said he had hoped that the switch to DVS would reduce the number of prior approval requests by 80%, but it's more like 20%. "If any item on the chair, like transport brackets, requires prior approval, the whole order gets held up," he said. "It's supposed to make things easier, but it doesn't always work that way." Providers are lobbying Medicaid to create a miscellaneous code that would prevent them from having to submit prior approvals for items that cost less than a "couple hundred dollars," Tobia said. Additionally, providers worry about audits under the new system. With no prior approval process for manual wheelchairs, providers are lobbying Medicaid for clear-cut coverage criteria. "You have to be careful what you wish for," said Dan Desimone, CEO of Continued Care of Long Island in Farmingdale, N.Y. "Before, we had a personal approval; now, the rules are a little more nebulous."