The U.S. Centers for Medicare & Medicaid Services' final decision on Medicare coverage for power elevation equipment in power wheelchairs shows that advocacy from ATPA and other organizations paid off and then some, with the agency announcing a coverage determination that applies to a much broader range of Medicare beneficiaries than expected.
In February, CMS proposed a national coverage determination, or NCD, that extended Medicare coverage for power seat elevation equipment on Group 3 power wheelchairs. APTA joined other provider and patient organizations in support of the NCD, but pressed CMS to do more by widening its focus, both in terms of wheelchair group levels and the types of transfers that would qualify for coverage.
CMS did that and more. The final NCD expands coverage to users of both Group 2 and Group 3 power-driven wheelchairs — a change advocated by APTA — but goes even further by allowing durable medical equipment contractors under Medicare to provide elevation device coverage for beneficiaries outside of those groups. That discretion is even extended to include Group 5 wheelchairs, for more specialized populations.
Another welcome change: a more inclusive list of the types of transfer needs that would qualify for coverage of the elevation equipment. The proposed rule limited coverage to users who perform weight-bearing transfers, a definition that APTA believed was too narrow. The association argued that beneficiaries who perform repetitive and necessary activities of daily living from a wheelchair are often at risk of developing musculoskeletal disorders as the result of repeatedly having to reach and look up, and they also should qualify for elevation device coverage. CMS agreed, expanding the list of qualified actions to include not only weight-bearing transfers, but non-weight-bearing transfers and mobility related to activities of daily living — toileting, grooming, cooking, dressing, and others.
"This NCD is going to have a very real, very positive impact on the lives of individuals across the country," said Andrew Amari, JD, APTA policy and payment specialist. "APTA applauds CMS' willingness to listen and expand coverage, and we're thankful for the APTA members who took the time to add their voices to our advocacy efforts during the public comment period."