Power wheelchair (PWC) users have scored a major victory, as the Centers for Medicare & Medicaid Services (CMS) announced that power seat elevation equipment on Medicare-covered PWCs falls within the benefit category of durable medical equipment (DME). Essentially, this decision means that more PWC users will now be eligible to receive coverage through Medicare for power elevation systems.
It is a monumental decision destined to positively impact thousands of lives and goes well beyond February’s initial decision from the CMS, in which the agency proposed coverage for seat elevation and deemed it necessary for those individuals who require elevation in Group 3 Complex Rehabilitative Technology (CRT) power wheelchairs to perform weight-bearing transfers.
However, following several months and multiple rounds of public comments and consideration, Tuesday’s announcement of CMS’s National Coverage Decision (NCD) expands well beyond the initial decision, which will cover seat elevation for the purposes of performing all transfers and mobility-related activities of daily living (MRADLs).
The decision summary states, in part, that individuals are eligible for coverage when the following conditions are met:
1. The individual has been evaluated by a medical professional to confirm they can safely use seat elevation; and
2. At least one of the following applies to the individual:
a. The individual performs weight-bearing transfers, with or without assistance;
b. The individual requires non-weight bearing transfers while in the home; or
c. The individual performs mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing, with or without assistance
Pride Mobility Products® Corporation and Quantum Rehab®, whose revolutionary iLevel technology has transformed tens of thousands of lives, are thrilled to share in the joy of power wheelchair users around the country who helped make Tuesday’s historic decision possible.
“For years, we’ve been advocating for Medicare to cover seat elevation,” said Stephanie Woodward, brand ambassador advisor for Quantum Rehab®.
“Wheelchair users across the country know firsthand how life-changing this technology can be, but for far too long, many people who needed seat elevation could not access it because Medicare wouldn’t cover it. With this new decision, we know that people who need this technology can finally have access to it. This is a huge win for our community!”
Overwhelming support for coverage beyond the preliminary decision was reflected in the two public comment periods. According to the Decision Memo, CMS received 3,523 “in-scope” comments during the initial comment period from August 15, 2022 to September 14, 2022. Of these, more than 98% supported “reasonable and necessary coverage of seat elevation equipment for Group 3 PWCs.” During the second comment period following the preliminary decision, CMS received 2,133 comments.
Hearing directly from wheelchair users, caretakers, friends, families, clinicians, and other medical professionals made a noticeable difference in CMS’s final decision.
“We are very pleased that CMS’s final decision incorporates many of the changes recommended by consumers and other stakeholders to include coverage for reach and all types of transfers into and out of a power wheelchair,” said Seth Johnson, senior vice president of Government Affairs for Pride Mobility. “This has been a seven-plus year effort with CMS, and it is great to see those efforts come to fruition. This is a historic victory for the disability community who led this effort, and one that should be celebrated.”
“I was truly overjoyed to see this announcement come through [Tuesday], said Quantum Rehab® clinical sales manager Alex Chesney, OTR, ATP/SMS. “It shows that our voices can be heard and especially those are utilizing and prescribing these features. Going from mainly only considering if seat elevation would help someone independently transfer on their own to considering it for a multitude of transfer styles, with or without a caregiver assisting, depending lift transfers, and function reach is a huge clinical win. This sets the stage that advocacy can work and is a step forward in promoting a life of quality and independence, not telling people that it’s a luxury if they utilize a power wheelchair.”
CMS also announced it expanded the scope of the initial benefit category decision “to include power seat elevation as DME on all Medicare-covered power
wheelchairs”, which include Group 2 with power options and Group 5 (pediatric) in addition to Group 3.
The full Decision Memo can be viewed here.
