Importance of the Centers for Medicare and Medicaid Services’ Policies for Wheelchair Claims

Importance of the Centers for Medicare and Medicaid Services’ Policies for Wheelchair Claims

Back in 2005, the Centers for Medicare and Medicaid Services (CMS) drew attention to the lack of a legal framework that will ensure the safety of wheelchairs. The CMS call was in relation to incidences of wheelchair malfunction and the need for backup features against equipment failure — considering that wheelchair and other forms of mobility devices are used for clinical care and rehabilitation.

As this government agency saw annual increases in the number of Medicare claims for wheelchairs, it became necessary to establish a set of safety and performance requirements to ensure that the equipment in use are based on the actual need of the wheelchair user. Such requirements include medical prescription and certification that there has been face-to-face examinations between the wheelchair user and the physician prescribing the wheelchair.

Actually, the CMS developed a comprehensive set of policies regarding documentations that the agency may require as support for a Medicare claim for wheelchair reimbursement; or in some cases, for the elimination of wheelchair as a medical necessity, as in the case of persons with disability (PWD).

Such requirements also made it necessary for wheelchair procurers to read the wheelchair buying guide before purchase is made in behalf of wheelchair users.

Background Info that Led to CMS’ Wheelchair Policies and Guidelines

Since the first wheelchair was invented in 1655, the years thereafter saw transformative developments in the designs of wheelchairs. As manufacturers came out with sophisticated models and other types of mobility devices, the standards observed in ensuring that wheelchairs are safe to use, were based on those set forth as customary by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).

RESNA was established in 1980 as the institution that formulated standards in the development and distribution of U.S. wheelchairs, which also gave attention to test methods and procedures used in the manufacture of safe wheelchairs. A decade later, the International Organization for Standardization (ISO) came out with a set of standards for quality of wheelchair manufacture and the related test methods, as required in other countries. .

While the U.S. Food and Drug Administration gave advice to wheelchair manufacturers to follow the standards set forth by RESNA and ISO, the CMS took note that no U.S.-based agency actually made compliance to such standards a critical requirement in the manufacture of wheelchairs.

As a result, the wheelchair market saw the proliferation of sophisticated wheelchair designs and the development of other mobility devices, where manufacturers had the option to select the kind of tests to apply to their respective products. The CMS also noted that some manufacturers and distributors even chose to create their own testing methods, while some others chose not to apply any tests at all.