Home Health & Hospice Week

Know how therapists will affect the way you furnish wheelchairs under the new rule.

Wheelchair suppliers won't just be working with physicians under the new power wheelchair rule--therapists will continue to play a major role as well.

Physical and occupational therapists handling high-end power wheelchairs won a small victory in the latest power mobility device (PMD) regulation released last month. The PMD final rule officially recognizes therapists' role in the prescription process--so they no longer have to worry about losing business to prescribing physicians.

What happened: The Centers for Medicare & Medicaid Services' interim final rule failed to mention a physical or occupational therapist's role in the wheelchair assessment process, but after an intense comment period, the final rule verifies that these roles can't be ignored.

"We acknowledge that PT and OT expertise can be an important contribution in some contexts. In addition, the [durable medical equipment regional carriers] have published an article describing a way to integrate PT/OT services into the evaluation process," CMS writes in the comments section of the final rule.

"Lawmakers claimed an active PT and OT role was implicit in the previous regulations, but we suggested in our comments to make that very clear and are pleased they did," says Dave Mason of the American Physical Therapy Association.

Effective June 5, the final rule fine-tunes provisions from the interim final rule regarding PMDs, which have been in effect since Oct. 25, 2005 (see Eli's HCW, Vol. XV, No. 15).

Therapists Team Up With Docs

The rule requires docs to conduct a face-to-face exam of the patient before prescribing a PMD. But that doesn't omit therapists from the picture, experts note. PTs and OTs can help tie up loose ends in fitting the patient with the proper wheelchair.

Best bet: "The therapist, the physician and the supplier should be working as a team," says Keela Barker, manager of outpatient rehabilitation for the Genesis HealthCare System in Zanesville, OH.

At Barker's clinic, patients come for a more detailed fitting and assessment after the doctor has done a face-to-face exam. For example, an OT might evaluate the patient's activities of daily living and determine appropriate hand controls, whereas a doctor may not have the background to do this.

"I don't think the final rule will change much of what we do except to add some steps to the process that will create an additional delay," says Irene Bartlett, PT rehab director for Mercy Medical Center in Des Moines, IA.

Therapists' main concerns are the local coverage determinations' (LCDs') stipulations, namely qualifications to participate in the prescription process of high-end power chairs, she adds.

LCDs currently require that therapists hold an Assistive Technology Practitioner (ATP) credential to participate in fitting a high-end PMD.