(WASHINGTON, DC) – The Independence Through Enhancement of Medicare and Medicaid (“ITEM’) Coalition has reaffirmed its request for Centers for Medicare and Medicaid Services (“CMS”) to expeditiously open a National Coverage Analysis (“NCA”) for Medicare coverage of standing systems in power wheelchairs (“PWCs”). The ITEM Coalition submitted its original National Coverage Determination (“NCD”) Request for Medicare coverage of both seat elevation and standing systems in 2020. CMS bifurcated the original two-part NCD request and granted coverage of power seat elevation in May 2023.  The request to cover standing systems is still pending at CMS.

Standing systems to perform or participate in Mobility Related Activities of Daily Living (“MRADLs”)—the standard for mobility device coverage under Medicare—are currently not covered. The ITEM Coalition is requesting that CMS formally open an NCA as expeditiously as possible to:

  1. Establish a benefit category determination (“BCD”) that standing systems in power wheelchairs are “primarily medical in nature” and, therefore, covered durable medical equipment (“DME”) under the Medicare program, and
  2. Explicitly recognize coverage of these systems as reasonable and necessary for beneficiaries with a medical or functional need for standing systems in Group 3 power wheelchairs in order to perform or participate in MRADLs in the home.

In a landmark decision, in May 2023, CMS announced Medicare coverage for power seat elevation systems as an accessory to power wheelchairs to benefit Medicare beneficiaries with mobility disabilities. The coverage decision represents a major advancement for the disability community and follows years of advocacy by the ITEM Coalition, as well as key national paralysis, disability, aging and clinical organizations.  Read more about this decision at https://www.powerslaw.com/medicare-covers-seat-elevation-for-medicare-beneficiaries-using-power-wheelchairs/.

“While the ITEM Coalition applauds CMS’s decision in 2023 to cover power seat elevation, we have waited nearly four years for CMS to open the NCA for standing systems coverage, and the time is now for CMS to finally act,” stated Peter W. Thomas, J.D., ITEM Coalition Co-Coordinator and Managing Partner of Powers law firm.

Co-Coordinator Michael Barnett, Director of Government Affairs at Powers, said, “These standing systems are critical for the health and functioning of people with mobility disabilities.  We strongly urge CMS to act immediately to get this coverage process moving.”

The ITEM Coalition is devoted to raising awareness and building support for policies that will improve access to and coverage of assistive devices, technologies, and related services for people with disabilities and chronic conditions of all ages. The coalition is consumer-led and includes a diverse set of disability organizations, aging and other consumer groups, voluntary health associations, and non-profit clinical associations.­­­

Read the full letter to CMS here.

­­­Powers Managing Partner, Peter Thomas, who works closely with the Healthcare and Government Relations & Public Policy teams at Powers, serves as lead counsel for the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition and was instrumental in coordinating this effort. Michael Barnett, Director of Government Affairs at Powers, co-coordinates this initiative.  The ITEM coalition is comprised of 100 national organizations and over the past several years has led a stakeholder effort to advocate for seat elevation and standing system coverage for Medicare beneficiaries.  Learn more about the ITEM Coalition at www.ITEMCoalition.org and https://www.rise4access.org/.

For more information, please contact ITEM Coalition Co-Coordinators, Peter Thomas and Michael Barnett at Peter.Thomas@powerslaw.com and Michael.Barnett@powerslaw.com or at 202-466-6550.


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