July 1 marked a significant victory for power wheelchair users, as the Centers for Medicare and Medicaid Services put into place a permanent policy that exempts complex power wheelchair components from Medicare’s competitive bidding process. The exemptions had been fought for by manufacturer, provider and disability advocates alike, including United Spinal Association (New Mobility is United Spinal’s membership magazine) because they allowed for better access to complex wheelchair components often necessary for those with neurological disabilities such as spinal cord injury, multiple sclerosis, and cerebral palsy.
“It’s huge for 85 percent of people or so on Medicare who use power wheelchairs,” says Alexandra Bennewith, Vice President, Government Relations, United Spinal Association. “On behalf of United Spinal, all of our members and everyone who attended the Roll on Capitol Hill this year and previous years, thank you all for doing a great job with keeping this issue alive with policymakers in Washington, D.C. You helped make a difference for your fellow wheelchair users across the country!”
For those with neurologic disabilities, complex rehab components such as contoured backrests, tilt/recline systems, and specialty controls, in addition to many others, can mean the difference between hospitalization and living independently in one’s community. “Wheelchair bases are useless without the right features on them,” says Bennewith.
Higher payment amounts under Medicare for certain categories of powered wheelchairs and related components, known as Group 3 and above were already in effect, under temporary exemptions granted in 2015 and 2016, but the second expiration was set to expire on June 30, 2017. Once expired, complex rehab power wheelchairs and components would only be reimbursed at the much lower rate used for standard wheelchairs and components, eliminating the financial incentive for durable medical equipment suppliers to offer complex components and service. The new exemptions permanently remove these power wheelchairs and related components from Medicare’s competitive bidding process.
Still, Bennewith stresses that this policy is only a partial victory, as manual wheelchairs and components are still subject to the restrictive competitive bidding payments.
“We got a win, but we got a win just for the power wheelchairs not for the manual. So we need to continue to push for manual,” she says. “It’s as if CMS doesn’t really understand they’re discriminating based on conditions, which they shouldn’t be doing. So if you have a certain condition that you need a manual chair, then you should be able to get that with the appropriate components.”
United Spinal and other advocacy groups vow that they will continue to fight to make complex manual wheelchairs and components exempt from CMS’ competitive bidding process.