CMS’ decision on power-seat wheelchairs: a partial win

This text is customized from STAT’s newest report, Decoding Medicare: 10 key protection choices and the way they’re made.

For years, sufferers and medical teams have advocated for Medicare to cowl wheelchairs with power-seat elevation, permitting customers to, amongst different issues, attain cupboards and counter tops extra simply and conduct conversations eye to eye.

In a significant shift in its strategy to the gadgets, the Facilities for Medicare and Medicaid Providers final month granted that request, saying it will cowl some wheelchairs with a power-seat elevation characteristic. The company stated in its determination that the power-seat gear could possibly be thought of a part of Medicare’s so-called sturdy medical gear profit, supposed to cowl merchandise used within the properties and for repeated use.

“For too lengthy, many individuals who use an influence wheelchair couldn’t entry on a regular basis objects of their properties and will have struggled to get out and in of their system,” CMS Administrator Chiquita Brooks-LaSure stated in a press release in regards to the determination. “This landmark Medicare determination to cowl seat elevation is a significant milestone that can enhance the standard of life for therefore many who depend on this expertise.”

Advocacy teams welcomed the brand new coverage. “This outcome exceeds our expectations and is being warmly embraced by the incapacity and rehabilitation communities,” wrote Peter W. Thomas, the coordinator of the Independence Via Enhancement of Medicare and Medicaid (ITEM) Coalition, in a Could 19 letter to CMS.

The ITEM Coalition contains each trade and shopper teams. The listing of organizations signing the letter included the Medical Gadget Producers Affiliation and the nonprofit Medicare Rights Heart, together with medical teams such because the Nationwide A number of Sclerosis Society.

However the determination, issued on Could 16, represents solely a partial win. In 2020, the ITEM Coalition had made formal arguments to CMS for protection of each power-seat elevation and power-standing for wheelchairs, citing medical proof that the options had been helpful to the well being and functioning of individuals in wheelchairs. Permitting individuals who use wheelchairs to attain a standing place on a frequent foundation, the ITEM Coalition argued, counters the medical problems related to extended sitting, similar to decreased vary of movement, kidney stones, urinary tract infections, and decreased lung perform.

CMS, in its determination, stated it additionally intends to think about the standing options of wheelchairs sooner or later, with out mentioning a particular time-frame.

The coalition stated it’s going to proceed to press CMS to cowl power-standing options, in addition to energy seats.

“​​For people who spend giant components of their day in a seated place, the worth of with the ability to stand, bear weight on the decrease limbs, and permit gravity to help in metabolic capabilities is effectively established within the medical literature,” Thomas wrote within the letter to CMS.

Nonetheless, the shift in Medicare’s stance offered a great instance of how CMS generally revisits its earlier choices, given new proof and continued advocacy by sufferers and producers, as STAT’s newest report, “Decoding Medicare: 10 key protection choices and the way they had been made,” explains.

In 2006, CMS had rejected a Johnson & Johnson request for protection of the corporate’s iBOT wheelchair. Priced at $26,100, the system may elevate individuals to standing peak and in addition climb stairs and curbs. In making its request for Medicare protection, J&J had argued that the system had important benefits over guide wheelchairs, energy wheelchairs, and energy scooters already coated by Medicare, which restricted individuals to sticking with comparatively flat, easy surfaces.

“By allowing the consumer to barter variable surfaces, climb curbs and stairs, and ‘stability’ at a standing eye-level place (whether or not at relaxation or in movement), the iBOT Mobility System just about neutralizes entry obstacles within the residence in addition to the group,” J&J stated in its request.

J&J had gained premarket approval in 2003 from the Meals and Drug Administration for the system, which means it had cleared the very best regulatory hurdles for gadgets. However the firm knew the request for Medicare protection can be a troublesome promote at CMS.

Making a proper pitch for iBOT protection in 2005, J&J had famous the challenges this request introduced for CMS. The iBOT was “a breakthrough expertise that doesn’t simply mesh with typical assumptions and expectations of mobility gadgets and the purposeful wants of beneficiaries,” J&J wrote.

The corporate stated CMS would wish to create a brand new kind of sturdy medical gear class for the wheelchair, requiring distinct codes.

In turning down J&J’s request in 2006, CMS stated that the iBOT’s seat elevation gear and stability perform couldn’t be coated as a result of they weren’t primarily medical in nature. The seat elevation, or standing characteristic, served the identical function as different gear that assisted individuals in reaching objects or having an eye-level dialog with a standing individual, CMS stated.

However teams such because the American Academy of Bodily Drugs & Rehabilitation (AAPM&R) challenged the concept the elevation characteristic supplied solely a superficial benefit in arguing for Medicare protection of the wheelchairs.

In a remark to CMS, AAPM&R famous that there was an fairness subject at play, as effectively. Extra prosperous individuals have been in a position to pay for seat-elevation options on their very own, whereas many different individuals can’t afford them, wrote Prakash Jayabalan, the chair of AAPM&R well being coverage and laws committee, urging CMS to finalize its proposal on protection. Finalizing the CMS proposal, because the company later did, can be a “main step ahead for the incapacity inhabitants,” Jayabalan wrote.

He added, “Permitting beneficiaries with a everlasting incapacity to entry expertise to face, attain, and performance of their residence and group, isn’t a luxurious, neither is it an merchandise of comfort, however a necessity.”