The Centers for Medicare & Medicaid Services (CMS) released a proposed National Coverage Determination (NCD) decision that would, for the first time, expand coverage for power seat elevation equipment on certain power wheelchairs toMedicare individuals. The proposed NCD is open for public comment for 30 days.
“Millions of people with Medicare rely on medically necessary assistive devices to perform daily tasks that directly impact their quality of life. CMS remains committed to ensuring persons with disabilities are receiving available benefits that improve their health,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s proposal promotes a first of its kind benefit expansion providing people with Medicare additional tools to improve their lives.”
If finalized, power seat elevation equipment would be covered by Medicare for individuals with a Group 3 power wheelchair, which are designed to meet the needs of people with Medicare with severe disabilities, in order to improve their health as they transfer from the wheelchair to other surfaces. Transfers often strain shoulder and back muscles and constrain an individual’s daily mobility at home and other customary locations.
CMS follows a long-standing process established by Congress to determine whether a medical item or service can be covered nationally by Medicare, including when an item or service is reasonable and necessary for the diagnosis of and/or treatment of an illness or injury. Today’s proposed NCD follows an evidence-based clinical analysis CMS initiated in August 2022 to examine whether the use of power seat elevation equipment on power wheelchairs: 1) falls within a Medicare benefit category and 2) if yes, whether it is reasonable and necessary.
Today’s NCD proposal incorporates feedback from interested parties, particularly those who are focused on eliminating health disparities for people with disabilities. CMS encourages comments from all interested parties, in particular, people with Medicare and their families, providers, clinicians, consumer advocates, health care professional associations, and from individuals serving populations facing disparities in health and health care. Additionally, CMS is specifically interested in gathering additional scientific literature that provides evidence surrounding the medical necessity for seat elevation systems through studies that include measurable characteristics related to the performance of transfers.
The proposed National Coverage Determination decision memorandum is available to review here. The 30-day comment period will close March 17, 2023.
For more information on the Medicare coverage determination process, please visit: Medicare Coverage Determination Process