1) In the past, medicare and insurance company policy regarding power wheelchairs was that if the patient could ambulate (walk) at all, they did not qualify for a power mobility device (PMD). In 2006, Medicare reduced the price they paid Durable Medical Equipment (DME) Suppliers by 43%. At that time they also laxed the requirments for PMD’s’ Now their policy reads that if the patient requires a PMD to carry out one or more activities of daily living (ADL) within their home, they MAY qualify for a Power Wheelchair.
2) DME’s now look at each case individually to help determine, along with the patient’s doctor, whether they meet Medicare guidelines for obtaining a PMD. Medicare wants a DME to deliver the most inexpensive device that the patient requires to carry out ADL’s in the home, so they require your Doctor to carry out a Face-to-Face Mobility examination prior to prescribing a PMD. The Doctor will asses whether a cane, walker, manual wheelchair or power scooter will meet the patents need within their home.
a) If a cane will help the patient move around their home to carry out ADL’s then that is the piece of equipment Medicare will provide. However, if a a cane will not work, then the Doctor will look at each additional assistive device (walker, manual wheelchair or power scooter). If he rules out each of these devices for his patient and can document in the patients record the diagnosis behind and the reason for prescribing a power wheelchair, then the patient could be eligible to receive a power wheelchair through Medicare and Insurance.
b) A few of the diagnosis that could lead to a Doctor prescribing a power wheelchair are as follows: End stages COPD; End stages Renal disease; Acute Arthitus; Acute Ostioarthritus, Diabetes; Heart Disease; Multiple Sclerosis; Muscular Distrophy; Paraplegia; Quadriplegia to name a few. Sometimes there will be a combination of diagnosis that lead to the prescription for a power wheelchair.
3) Many patients are confused as to where they can use their power wheelchairs that Medicare and Insurance pays for.
a) Your Doctor and DME Supplier have to qualifiy the patient for “In Home” us of the chair. The patient must need this equipment to enable them to carry out one or more activities of daily living within their home. i.e getting from one end of the house to the bathroom on time; being able to get around in their kitchen for meals, to to the laundy room for laundry, etc.
b) Medicare and insurance are only interest in the patient being able to continue to be mobile within their home. By doing so, it allows the patient to remain at home rather than having to go into a 24 hour care facility. The longer a person can stay at home, the better their quality of life is plus the cost of a power wheelchair (while fairly expensive) is insignificant compared to the cost to Medicare for 24 hour care in a nursing home or assisted living facility. There is a huge savings to Medicare if a power wheelchair allows to patient to remain home for an additional 1, 2, 5 years.
c) Once a patient qualifies for need within the home for a power wheelchair and a PWC is delivered, then the chair belongs to the patient and they can use it indoors and outdoors as they wish. Many patients purchase lifts for their vehicles or Mobility Conversion Vans that allow them to stay completely mobile by allowing them to take the power wheelchairs with them wherever they go.
d) Medicare will consider replacing a PWC every 5 years and they will also cover many of the repair costs during that 5 year period.
With an aging society (an average of 20 million Americans per year will turn age 65 over the next 10 years) Medicare realizes that they will be purchasing many more power wheelchairs than in the past (only 2.2 million Americans were age 85 or older in 2008) and they are working with manufacturers and suppliers of power wheelchairs to drive down their cost. At the same time they are making it more restrictive to be a supplier of power wheelchairs and other DME related items by mandating that every DME Supplier must go through an extensive accreditation process to do business with them.
