On February 5, 2005,
Centers for Medicare & Medicaid Services (CMS) released a draft on criteria for power wheelchairs and scooters coverage. These criteria will rely on clinical guidance for determining need. The new analysis begins with an assessment if beneficiary has a mobility limitation preventing him/her from performing one or more mobility-related activities, like household chores at home. This evaluation also considers if use of assistive device – whether a simple cane or a sophisticated power wheelchair or anything in between would improve beneficiary’s ability to function within home. Taking into account visual or mental impairment, criteria further evaluates what would affect beneficiary’s ability to use mobility equipment (power wheelchair) effectively.
According to CMS Chief Medical Officer Sean Tunis, M.D., draft of coverage criteria was intended to provide a clear and consistent guidance to Medicare contractors and clinician. This guide will ensure that beneficiaries receive type of mobility device that will provide clinical benefits. Tunis was one who spearheaded agency’s move to a more functional assessment of mobility needs.
CMS also released new codes to ensure proper payment. These plans were outlined in Modern Mobility Initiative announced last April. They are also launching new billing codes for power wheelchairs and scooters to ensure that Medicare pays appropriately for these devices.
The final NCD is planned to be published in March to provide guidance on how to use and document new criteria. However, these efforts of CMS were criticized by Medicare Rights Center, saying that new wheelchair coverage policy does not provide mobility and independence for disabled and impaired people. The new approach of Medicare’s proposed coverage criteria would replace an older, more rigid standard that relied on whether a patient was “non-ambulatory” or “bed or chair confined”. The new proposed criteria would rely on clinical guidance for evaluating whether a beneficiary needs a device to assist for mobility, and if so, what type of device is needed.
