Kansas City Star | 01/17/2006 | New rules hinder mobilityPower wheelchairs and scooters are often advertised as, basically, free; however, note that the advertiser carefully includes the phrase "if you qualify". Medicare established guidelines for qualifying for power wheelchairs and scooters some time ago. This article discusses recent changes to the Medicare rules concerning power mobilty equipment. However, this article contains some major errors about Medicare coverage for power wheelchairs and scooters, and these should be clarified.
I deal with mobilty everyday, so I know what Medicare rules are for power wheelchairs and scooters. Medicare did eliminate the CMN (certificate of medical necessity), replacing that confusing and burdensome document with a PRESCRIPTION! The power wheelchair prescription is written on a regular prescription blank. Power wheelchair/scooter prescriptions must also include information as to diagnoses and expected length of need for the mobility equipment. The CMN required this same informatoin, but the document was confusing, and doctors sometimes stalled for weeks before they filled them out. By comparison a prescription, which is all that is required to order a power mobility device under the new rule, is something the doctor deals with everyday and is accustomed to. Most doctors don't see the prescription as so burdensome.
The new Medicare rule for power mobilty equipment does require that the patient have a face to face examination within 30 days. THE PATIENT DOES NOT HAVE TO WAIT 30 DAYS AFTER THE APPOINTMENT TO GET THEIR POWER WHEELCHAIR OR SCOOTER!! If the patient has not seen the doctor within the last 30 days, the patient needs to be seen by the doctor for a mobility evaluation, which Medicare DOES pay for, along with reimbursing the doctor for his time with the paperwork required. The power mobilty supplier must receive the prescription, progress notes for this exam, and any other documentation (imaging reports, therapy evaluations, etc.) that supports the patients need for power mobility within 30 days of that exam. This shouldn't be difficult as the doctor/practitioner would have to write progress notes from the examination anyway!. Certainly it's not unreasonable to expect the patient to have seen the doctor face-to-face within the last 30 days. There was no such time restriction under the old rules, but I can see why Medicare would prefer not to have a doctor order a power wheelchair or scooter when they haven't seen the patient in 6 months. Most doctors that I have worked with for mobilty would require the patient to come in anyway if it had been more than a couple of months since their last visit.
The basic Medicare qualifications for power mobilty equipment have not changed, except for the better. These qualifications include the following: 1. The patient must require the mobility equipment for use in the home, and must have a mobility limitation that interferes with mobilty-related activities of daily living (ADLS), such as dressing, toileting, bathing, grooming and eating. By comparison, the old coverage determination required that the patient be bed- or chair-confined and 2. that he patient be unable to operate a manual chair. Actually, Medicare loosened restrictions by eliminating the "bed- or chair-confined" rule.
Medicare has not restricted payment for power mobility equipment. They did establish an algorithm for determing the appropriate mobilty assistive device. Medicare wants to get by as cheap as they can, presumably to save our tax dollars. If a cane, walker, or manual wheelchair will adequately meet the patient's mobility need, then Medicare will not pay for power mobilty equipment. And if the patient is able to operate a scooter, Medicare will not pay for a more expensive power wheelchair. It's simple as that.
If you have questions about qualifying for power mobility equipment, you can contact Medicare. However, don't rely solely on what the customer service rep at Medicare tells you. You can also contact a well-known, reliable supplier who might help you get the power mobilty equipment you need.
Information on power mobilty equipment here!
