This text is tailored from STAT’s newest report, Decoding Medicare: 10 key protection selections and the way they’re made.
For years, sufferers and medical teams have advocated for Medicare to cowl wheelchairs with power-seat elevation, permitting customers to, amongst different issues, attain cupboards and counter tops extra simply and conduct conversations eye to eye.
In a significant shift in its method to the gadgets, the Facilities for Medicare and Medicaid Companies final month granted that request, saying it could cowl some wheelchairs with a power-seat elevation function. The company mentioned in its determination that the power-seat tools could possibly be thought-about a part of Medicare’s so-called sturdy medical tools profit, supposed to cowl merchandise used within the properties and for repeated use.
“For too lengthy, many individuals who use an influence wheelchair couldn’t entry on a regular basis gadgets of their properties and will have struggled to get out and in of their machine,” CMS Administrator Chiquita Brooks-LaSure mentioned in an announcement in regards to the determination. “This landmark Medicare determination to cowl seat elevation is a significant milestone that can enhance the standard of life for therefore many who depend on this know-how.”
Advocacy teams welcomed the brand new coverage. “This end result exceeds our expectations and is being warmly embraced by the incapacity and rehabilitation communities,” wrote Peter W. Thomas, the coordinator of the Independence By Enhancement of Medicare and Medicaid (ITEM) Coalition, in a Might 19 letter to CMS.
The ITEM Coalition consists of each trade and shopper teams. The listing of organizations signing the letter included the Medical Gadget Producers Affiliation and the nonprofit Medicare Rights Middle, together with medical teams such because the Nationwide A number of Sclerosis Society.
However the determination, issued on Might 16, represents solely a partial win. In 2020, the ITEM Coalition had made formal arguments to CMS for protection of each power-seat elevation and power-standing for wheelchairs, citing medical proof that the options have been helpful to the well being and functioning of individuals in wheelchairs. Permitting individuals who use wheelchairs to attain a standing place on a frequent foundation, the ITEM Coalition argued, counters the medical problems related to extended sitting, equivalent to decreased vary of movement, kidney stones, urinary tract infections, and lowered lung operate.
CMS, in its determination, mentioned it additionally intends to think about the standing options of wheelchairs sooner or later, with out mentioning a particular timeframe.
The coalition mentioned it’s going to proceed to press CMS to cowl power-standing options, in addition to energy seats.
“For people who spend massive elements of their day in a seated place, the worth of with the ability to stand, bear weight on the decrease limbs, and permit gravity to help in metabolic capabilities is nicely established within the medical literature,” Thomas wrote within the letter to CMS.
Nonetheless, the shift in Medicare’s stance offered a superb instance of how CMS generally revisits its earlier selections, given new proof and continued advocacy by sufferers and producers, as STAT’s newest report, “Decoding Medicare: 10 key protection selections and the way they have been made,” explains.
In 2006, CMS had rejected a Johnson & Johnson request for protection of the corporate’s iBOT wheelchair. Priced at $26,100, the machine might carry individuals to standing top and likewise climb stairs and curbs. In making its request for Medicare protection, J&J had argued that the machine had vital benefits over handbook wheelchairs, energy wheelchairs, and energy scooters already lined by Medicare, which restricted individuals to sticking with comparatively flat, clean surfaces.
“By allowing the person to barter variable surfaces, climb curbs and stairs, and ‘stability’ at a standing eye-level place (whether or not at relaxation or in movement), the iBOT Mobility System just about neutralizes entry limitations within the residence in addition to the group,” J&J mentioned in its request.
J&J had received premarket approval in 2003 from the Meals and Drug Administration for the machine, that means it had cleared the very best regulatory hurdles for gadgets. However the firm knew the request for Medicare protection could be a troublesome promote at CMS.
Making a proper pitch for iBOT protection in 2005, J&J had famous the challenges this request introduced for CMS. The iBOT was “a breakthrough know-how that doesn’t simply mesh with standard assumptions and expectations of mobility gadgets and the useful wants of beneficiaries,” J&J wrote.
The corporate mentioned CMS would want to create a brand new sort of sturdy medical tools class for the wheelchair, requiring distinct codes.
In turning down J&J’s request in 2006, CMS mentioned that the iBOT’s seat elevation tools and stability operate couldn’t be lined as a result of they weren’t primarily medical in nature. The seat elevation, or standing function, served the identical objective as different tools that assisted individuals in reaching gadgets or having an eye-level dialog with a standing individual, CMS mentioned.
However teams such because the American Academy of Bodily Drugs & Rehabilitation (AAPM&R) challenged the concept that the elevation function provided solely a superficial benefit in arguing for Medicare protection of the wheelchairs.
In a remark to CMS, AAPM&R famous that there was an fairness challenge at play, as nicely. Extra prosperous individuals have been in a position to pay for seat-elevation options on their very own, whereas many different individuals can’t afford them, wrote Prakash Jayabalan, the chair of AAPM&R well being coverage and laws committee, urging CMS to finalize its proposal on protection. Finalizing the CMS proposal, because the company later did, could be a “main step ahead for the incapacity inhabitants,” Jayabalan wrote.
He added, “Permitting beneficiaries with a everlasting incapacity to entry know-how to face, attain, and performance of their residence and group, shouldn’t be a luxurious, neither is it an merchandise of comfort, however a necessity.”