Stakeholders ask CMS to make seat elevation a priority

WASHINGTON - The ITEM Coalition's Peter Thomas is bullish on a recent formal request to reconsider the national coverage determination for mobility assistive equipment to include power seat elevation and power standing systems for Group 3 power wheelchairs.

“We believe coverage of these features is inevitable - there's no question they will be covered in the future - and we believe CMS should be leading in this respect,” said Thomas, a principal at Powers Law Firm and coordinator of the ITEM Coalition.

The ITEM Coalition, supported by dozens of experts, including power wheelchair users, clinicians, ATPs and disability advocates, submitted the request to CMS in September.

At issue

The request challenges a decision by the DME MACs way back in 2005 that power seat elevation and power standing systems are not “primarily medical in nature” and, therefore, should not be included in the DME benefit. The request counters that with more than 120 peer-reviewed studies supporting the medical benefits of the systems, which include everything from enabling transfers from one surface to another, a key aspect of achieving the mobility related activities to daily living or MRADLs that are already part of the coverage criteria; to increasing a user's circulation; to improving their GI function.

“(The contractors) believe this is primarily for the convenience of the beneficiary and we flatly reject that,” Thomas said. “We have a large evidence base that demonstrates otherwise.”

Common sense

Thomas points out that, per Medicare rules, a system becomes part of DME if it is attached to or is integral to that DME. Such is the case for power seat elevation and power standing systems to power wheelchairs, he says.

“Seat elevation is embedded in the power wheelchair,” he said, “so the lack of coverage is inconsistent with Medicare law.”

It takes a village

The ITEM Coalition created four work groups (clinical, reimbursement/technology, legal and congressional/advocacy) to work on the request, drawing input and feedback from more than 60 national organizations across the disability and rehabilitation spectrum.

“It's been hours and hours of work, and we have a lot of people to thank,” Thomas said. “It was a team effort because we didn't want anyone from the community saying, 'We don't agree with that, it's too restrictive.' We built in every constituent and stakeholder we could think of. There's a lot of buy in for this request.”

What's next

CMS must now review the request and determine if it's complete. After that, the agency and various offices within the agency will begin a two-pronged process of determining: what are the benefits of the systems; and is it reasonable and necessary.

“This ought to be viewed as a priority,” Thomas said. “It's not a convenience to be able to bear weight on your limbs so you can improve your bodily functions. Those aren't conveniences; those are clinical needs.”