The letter comes after CMS announced it would expand its mobility benefit to include coverage of seat elevation systems for power wheelchair users. This coverage is critical for individuals with disabilities who rely on seat elevation to transfer from one surface to another or improve one’s reach. However, this decision did not consider coverage of standing systems.
“Coverage of standing systems will bring significant benefits to Medicare beneficiaries with mobility disabilities. Therefore, we respectfully urge you to move forward with opening the NCD and public comment period regarding coverage of power standing systems,” the lawmakers write. “For individuals who spend large parts of their day in a seated position, the value of being able to stand, bear weight on the lower limbs, and allow gravity to aid in metabolic functions is well established in clinical literature. As we celebrate the major milestone in seat elevation coverage, we urge CMS to press forward with the opening of an NCD on standing systems in power wheelchairs."
“We write to also urge CMS to examine its coverage of mobility equipment for Medicare beneficiaries, including its current interpretation of the “in the home” requirement. As you know, access to appropriate mobility equipment is especially critical for those living with amyotrophic lateral sclerosis (ALS), cerebral palsy, limb amputation, lupus, multiple sclerosis, muscular dystrophy, myositis, Parkinson’s disease, spina bifida, spinal cord injury, paralysis, rheumatoid arthritis and other mobility-related conditions and disabilities,” the lawmakers continue. “However, we are concerned the “in the home” language is limiting beneficiaries’ access to equipment designed only for in-home use, serving as a barrier to participation within the community. Due to a restrictive interpretation of the “in-the-home” rule, limits to Medicare coverage coding and payment policies, and the adoption of Medicare coverage policy by private insurers, wheelchair users are facing constant insurance denials and delays in obtaining appropriate equipment which can result in health injuries and secondary health conditions such as pressure injuries (pressure sores) and rotator cuff and carpal tunnel injuries (due to overuse of wheelchair users’ upper extremities).
“For these reasons, we urge CMS to conduct a full review of its current mobility device coverage, coding, and payment policies, including the “in the home” interpretation, to determine whether they are suitable in meeting the mobility needs of beneficiaries both within their homes and within their communities,” the lawmakers conclude. “If CMS cannot modify the mobility device benefit through the regulatory process, we look forward to working with you toward a legislative solution.”
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