Stakeholders ‘jump on opportunity’

WASHINGTON – When CMS publishes a final national coverage determination for power seat elevation systems on May 15, industry stakeholders will be on the lookout for several of their recommendations, including expanding coverage to Group 2 wheelchairs. 

In a proposed NCD released in February, CMS moved forward with expanding coverage to Group 3 wheelchairs, per the ITEM Coalition’s original request for redetermination, but the agency also asked for comments on expanding coverage to Group 2. 

“We’ll be looking for coverage for Group 2, as well,” said Joe Nahra, director of government relations at Powers Law Firm and co-coordinator of the ITEM Coalition. “CMS opened the door to potential coverage for Group 2 and we wanted to jump on that opportunity.” 

Nahra credited the Clinician Task Force and others for developing new evidence “on the fly” to support applying coverage to Group 2 so stakeholders could include it as part of their comments on the proposed NCD. 

Stakeholders also recommended expanding coverage not only for transfers but also for improved reach and line of sight; ensuring coverage applies to wheelchair users who need fully dependent transfers or who use patient transfer devices like lifts; and aligning coverage with existing requirements for complex rehab wheelchairs, like having an ATP involved in evaluations. 

“We’re really pleased with how it came out, but there’s room for improvement,” Nahra said. “We’re hoping they’ll take the comments to heart, look at the medical evidence and make the changes we’re recommending.” 

While they wait for CMS to publish the final NCD, stakeholders aren’t “sitting on our heels,” Nahra says. They’re continuing to engage with CMS not only on power seat elevation systems but also power standing systems, which the agency did not move forward with in its proposed NCD. 

“They have committed to doing a similar process for standing systems,” he said. “We’re keeping the pressure on that it’s next on the docket for expanding Medicare coverage.”