PDF Version (109 KB)

ITEM Coalition Views CMS Announcements on Wheelchair Policy as “Mixed Bag”

[Washington, DC] – The ITEM Coalition today recognized the importance of CMS’ new direction in setting Medicare wheelchair coverage policy based on a functional assessment of each beneficiary, rather than whether or not beneficiaries are considered “bed or chair” confined, but expressed disappointment with the pace of progress and CMS’ apparent refusal to adequately address the “in the home” restriction.

On December 15, 2004, CMS released recommendations drafted by the Interagency Wheelchair Workgroup (IWWG) that serve to initiate the NCD process for wheelchairs under Medicare. Including the current 30-day comment period, CMS will have up to 6 months to develop a draft decision memorandum. An additional comment period will follow the release of that memorandum.

CMS’ announcement to begin the NCD process signals a more formal, time-limited procedure in which to review Medicare wheelchair coverage policy. But it also signals an additional delay in CMS’ handling of this issue.

“We were awaiting the release of actual draft guidance from CMS, but instead, we seem to be at the beginning of this process, again. We are hopeful that CMS will accelerate its timeframe so that beneficiaries do not lose access in the meantime,” stated Kim Ruff-Wilbert of the United Spinal Association and an ITEM Coalition Steering Committee Member.

The ITEM Coalition applauds the IWWG for recommending functional criteria as the basis for coverage of wheelchairs and considers these recommendations to be important steps toward a more comprehensive benefit. However, the ITEM Coalition continues to be disappointed by the perpetuation of CMS’ interpretation of the “in the home” restriction in the IWWG’s recommendations.

The “in the home” restriction (originally meant to define durable medical equipment (DME) as devices that were provided outside of an institution such as a hospital or skilled nursing facility and, therefore, warranted separate reimbursement under Medicare Part B) has been interpreted by CMS to restrict coverage only to wheelchairs and other mobility devices that are reasonable and necessary within the beneficiary’s home.

###