Yesterday afternoon (May 16th), CMS announced its decision to cover for Medicare beneficiaries with mobility disabilities seat elevation in all power wheelchairs for the purposes of performing all transfers or to improve reach in performing mobility related activities of daily living (MRADLs) in their homes. This is a major expansion of coverage from the preliminary coverage decision announced in mid-February and CMS attributed these coverage improvements to the 2,130 public comments received by wheelchair users, advocates, clinicians, and researchers. The final seat elevation Decision Memo can be viewed HERE.
For the first time, CMS determined that seat elevation in power wheelchairs is considered “primarily medical in nature” and is, therefore, covered durable medical equipment (DME) under both traditional Medicare and Medicare Advantage. Seat elevation will be covered in Groups 2, 3 and 5 Complex Rehabilitative Technology (CRT) power wheelchairs when a patient needs seat elevation to transfer from one surface to another, with or without caregiver assistance, assistive devices, or lift equipment or to improve one’s reach in order to perform MRADLs. Seat elevation will also be covered in non-CRT power wheelchairs when determined by Medicare contractors to be reasonable and necessary. Individuals must undergo a specialty evaluation performed by a licensed/certified medical professional who has specific training and experience in rehabilitative wheelchair evaluations.
This decision is effective immediately but CMS will consider new coding and payment determinations in the future. Beneficiaries who are most likely to benefit from this decision include people with Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, spinal cord injury, paralysis, ALS, limb amputation, Lupus, rheumatoid arthritis, myositis, and other mobility-related conditions.
This finalized national coverage determination represents a major victory for wheelchair users which will likely have ripple effects with other payers, including commercial health plans. Also pending at CMS is another coverage request for standing systems in power wheelchairs, also an ITEM Coalition request. That process has not yet begun.
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. The ITEM coalition is comprised of nearly 100 national organizations and over the past several years has led a stakeholder effort to advocate for coverage, including preparing and drafting a comprehensive and extensively-sourced National Coverage Determination Reconsideration Request, coordinating support for national disability, rehabilitation, patient, clinician, and industry organizations, garnering support from Members of Congress and Administration officials, and more. The ITEM Coalition also created a comprehensive website for coalition members and supporters to access resources to help guide them in advocating for coverage, as well as a petition urging CMS to move forward with approving coverage. Ron Connelly, Christina Hughes, Leela Baggett, Natalie Keller, Michael Barnett, and former Powers employee, Joseph Nahra, also worked on the issue and were instrumental in making this effort successful.