Home Health & Hospice Week

CMS dodges industry's concerns over latest Operation Wheeler Dealer measure.

A so-called "clarification" to the national wheelchair and scooter coverage policy could mean suppliers of the items will be providing many fewer of them in the future.

Power wheelchairs and scooters "are covered only for patients who are nonambulatory," says the clarifying message issued by all four durable medical equipment regional carriers in December. "If the patient is able to walk either without any assistance or with the assistance of an ambulatory aid, such as a walker, the power wheelchair is denied as not medically necessary."

"It's much more than a clarification; it's actually a change in policy," says Sharon Hildebrant, executive director of the American Association for Homecare's Rehab and Assistive Technology Council. "If [a patient] can take three to five steps, they may not qualify to get a power wheelchair under this current clarification, even though they may not be functionally ambulatory," Hildebrant says in a statement decrying the policy change.

Formerly, a patient's ability to perform activities of daily living governed coverage, she notes.

"These policy changes, however, will have no impact on fraudulent firms' behavior," Invacare CEO Malachi Mixon wrote in a letter to CMS and the DMERCs. "Instead, these policy changes will simply prevent many needy beneficiaries from being able to get around inside their homes."

"All DMERCs are strictly enforcing these coverage criteria and applying them to all claims reviewed regardless of the date of service or date of submission," the DMERCs say in the clarification.

Suppliers were eager to give CMS an earful over the drastic change couched as a mere clarification in the Jan. 15 Open Door Forum for home care providers. "How can CMS and the DMERCs think that they will get away with the idea that this is clarification on wheelchairs, when basically what they are doing is confining [a beneficiary] completely to being wheelchair confined?" a strident Dr. Paul Metzger, former medical director for Region C DMERC Palmetto GBA and current vice president of government relations for The Scooter Store based in New Braunfels, TX, demanded of CMS officials in the forum. A patient who takes "one step can no longer qualify for either a manual or a power wheelchair," Metzger objected.

Erik Sokol of the Power Mobility Coalition noted in the forum that the coalition had requested a meeting with CMS officials about the controversial new policy, and had gotten no response.

CMS Ducks Trade Group Meeting 

A CMS official answered that a meeting about the policy with the coalition and other trade associations was "under consideration," but that the CMS officials "just don't have an answer right now."

Other DME items covered in the open door forum include: