Show Your Support at www.rise4access.org to Advocate for Coverage, Register for Updates, and/or Sign the Coverage Petition
Visitors to the lobby of the Christopher and Dana Reeve Foundation headquarters have been greeted by the powerful sight of Christopher Reeve’s wheelchair which he used following a horse-riding accident that left him living with paralysis. Although Christopher Reeve died in 2004, it strikes an observer of his wheelchair, seemingly high-tech at that time, how functionally limiting his wheelchair options were. Today’s wheelchairs, with proven technological advancements, have greater potential to improve the health, safety, and quality of life of individuals who have access to wheelchair advancements. Unfortunately, Medicare coverage has not kept up with the reasonable needs of many individuals who depend on wheelchairs and to whom access to critical technological functionality has been unfairly denied.
Seat elevation is one of the technological advancements in wheelchair design that is integral to maximum functioning for certain beneficiaries. A wheelchair system, also referred to by the Centers for Medicare and Medicaid Services (CMS) as an “accessory” to a wheelchair frame, seat elevation allows individuals with certain medical needs who use wheelchairs to achieve a variety of vertical height options with a chair. The ability to alter the elevation of a wheelchair seat has many benefits, including:
- Making it safer for an individual to transfer from place to place at the same height, thus reducing the risk of falls and fractures (for example, moving from bed to wheelchair, or wheelchair to toilet);
- Helping to prevent long-term physical damage to an individual’s neck, back, and overall body alignment caused by constantly having to look up at standing individuals, instead allowing people to engage eye-to-eye;
- Allowing individuals to achieve greater independent access to activities of daily living with less reliance on aides or caregivers (such as reaching into higher cabinets or looking down into a boiling pot on the stove to prepare dinner); and,
- Providing immeasurable psychological and quality-of-life benefits.
In 2004, the Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) published a Local Coverage Article (LCA) A52504 (last revised in 2020) which continues to maintain that power seat elevation systems are “not primarily medical in nature” and, therefore, are Medicare non-covered. On September 15, 2020, the ITEM (Independence Through Enhancement of Medicare and Medicaid) Coalition submitted a Formal Request for Reconsideration of the Medicare National Coverage Determination, a thoroughly researched and compelling document, making a strong case that CMS should determine that seat elevation systems for wheelchairs are primarily medical in nature and are covered within the Medicare statutory definition of durable medical equipment. Now, almost two years after the ITEM Coalition submitted a request for review, CMS is providing the public an opportunity to comment.
CMS is accepting public comment through September 14th at https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspxncaid=309&fbclid=
IwAR0v8unyjFbQwI1D3fqyEgeTFO0jYAJIsdrWGlo30LEWm4S3SdbNl8a_On4. Also access the ITEM Coalition website addressing this topic at www.rise4access.org.
August 25, 2022 – K. Holt