Another chance to make your voice heard on the need for covering power seat elevation equipment for group 3 power wheelchairs.
by Melanie Hamilton-Basich
The Centers for Medicare & Medicaid Services (CMS) has released a proposed National Coverage Determination (NCD) decision that would expand coverage for power seat elevation equipment on group 3 power wheelchairs through Medicare. The proposed NCD is open for public comment until March 17, 2023.
This is the continuation of the process that began 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.” The expected completion date for the National Coverage Analysis of seat elevation systems is May 16, 2023.
Related: CMS Opens Consideration for Seat Elevation Systems Coverage
If finalized, this expansion in coverage would benefit so many wheelchair users. And that’s what this is all about, as I’m sure anyone reading this knows all too well.
Kirsten Davin, OTD, OTR/L, ATP, SMS, is an occupational therapist and expert in the seating and positioning industry who is a strong proponent of this change, because she knows how important it could be. Here, she shares an example of the impact such equipment can have on wheelchair users.
“The CMS proposal for power seat elevation equipment on Group 3 power wheelchairs to potentially fall within the benefit category for durable medical equipment (DME) is a decision that has the potential to offer life-changing opportunities for a multitude of wheelchair users,” Davin states.
“In my Fall 2021 Rehab Management article, Freeing Effects of Seating Functionality, I discussed the case of Lucille, a 92-year-old farm wife who presented with significant limitations in functional mobility and the performance of activities of daily living due to multiple diagnoses. We assisted her in acquiring a power seat elevator, which resulted in a vast improvement in independence. It allowed her to once again independently transfer to and from the wheelchair to multiple surfaces, access her refrigerator, perform meal preparation and other tasks on the kitchen counter, fully access cabinets, complete a load of laundry and, in Lucille’s opinion, most importantly, elevate her seat to look out the kitchen window to check on her son and grandson who were working in the field.
“Fortunately, Lucille had the funds to privately pay for the power seat elevation component, but many across the country do not. This feature was a valuable component that played a role in keeping her in her home, independently for several years to come. I support and welcome the possibility of CMS providing coverage for the power seat elevation feature as it has the potential to offer thousands of wheelchair users a new level of freedom, independence, and self-sufficiency, while allowing the consumer an increased opportunity to age in place, staying in their home as long as possible.”
This is just one example of how this expansion in CMS coverage could improve people’s lives. And you have a chance to influence the decision.
Related: Justifying Power Seat Elevation and Standing Systems
In the statement announcing the proposal, CMS encourages feedback from all interested parties, including clinicians. The proposed National Coverage Determination decision memorandum is available to review, and includes a link at the top of the page to submit public comments. The 30-day comment period will close March 17, 2023.
Will you submit public comments? Do you have a story to share about the need for seat elevation system coverage expansion? Let us know in the comments below.
The cost difference on mine would have been negligible. – the chair was the same price with and without it, the only requirement was a different controller. The 195 price savings in not adding the lift controller has cost thousands and will continue to cost thousands in needing paid assistance, and modifications to my home, public locations, school, and in the future, work. It also costs my self-determination – I can’t take care of myself as well as I would if I could be the height that most places are built for, and when with people who are walking or standing, etc. I am young and have many years where not having a wheelchair that will allow me to be at different heights will cost thousands in the future as well. I would have paid for it because there is so much I could do independently that I can’t do now. After all, it was not ordered. I was not given the option since it was considered not a covered item. Rather than modifying the environment for the lower height of wheelchairs everywhere in homes and public, motorized wheelchairs are much more cheaply equipped.
I can do much more if I can reach things myself. I do not have an assistant standing by all the time. For someone who is in a chair all day except for hygiene reasons or sleeping, the low seated position makes many things impossible. so without the ability to reach. For example, I cannot cook on a stove due to poor shoulder integrity and run the risk of burning myself, cannot pick up items from a counter, and for those items that I do, I can’t work on the counter, but have to transfer it to my wheelchair and transport it to a place where I can work, and then have trouble putting it away. Tables at different places are at different heights so I can’t use many tables, while in my wheelchair, and am limited in how many transfers I can do to try to use a chair that is at a table – all that because the wheelchair is not adjustable. For someone with extreme limitations on lifting arms, grasping, reaching items, trying to pick something up from a counter, or a shelf, or take something from someone else who is standing, with a grabber because it is too high is not possible. First, I can’t squeeze the grabber hard enough, and I cannot lift heavier items. If I could be at the counter or standing level, I would not risk dislocations of both my shoulders and could use both hands to pick an item up. Items include mail, books, food, a computer, and anything someone is handing me. I also run the risk of dropping whatever it is as I try to bring it down to my level. I cannot reach into a sink to wash my hands, get water, or wash dishes or rinse my food. I can’t reach clothes or books etc. that are hanging or are on shelves that other people could reach. For school and work, I would have to have people hand me things that others can walk to and get all the time. My wheelchair can get me there, but then it is too low, and I can’t reasonably stand to get the items. I also have trouble with my neck which becomes painful if I have to look up to talk to people, and I cannot see people behind counters, and cannot hear them well enough from far away where I can see them. Because I can not have a polite conversation where I can look at people who are above me and cannot hear them when they are far enough away to make eye contact, it may seem I am asocial and conversations are not just difficult for me, it is for others as well. . It is difficult enough that the chair requires extra space.
The extra cost of not being able to independently perform basic functions such as cooking, cleaning, tidying, and conducting business, which now requires an assistant, or purchase and physical modification of work, school, home, government, etc environments, for every wheelchair user – to bring everything lower, does not make economic sense and unnecessarily reduces the quality of life and is prohibitive of even doing many activities which would be reasonably possible otherwise.