The lack of a clinical template for physicians to order power wheelchairs for patients will increase institutionalizations among Medicare beneficiaries when a large-scale pilot launches next month, according to a provider advocacy group.
Group says power wheelchair orders needs clinical template before pilot launches
The American Association for Homecare this week warned that a CMS prior authorization pilot program for that equipment that is set to begin Sept. 1 in California, Florida, Illinois, Michigan, New York, North Carolina and Texas will have adverse consequences.
“There will be Medicare beneficiaries forced to leave their homes for expensive nursing homes and other care facilities because they won't receive the power wheelchairs prescribed by their physicians,” Tyler Wilson, president and CEO of the AAH, said in a news release (PDF).
The program could avoid such adverse outcomes, he said, by finalizing a clinical template for physicians to document a patient's medical need for mobility assistance. The CMS is developing such a template but will not have it ready before the three-year demonstration program launches.
The concerns are based on the high rates of denials Medicare beneficiaries receive for power wheelchairs under current rules, which are frequently overturned on appeal. However, the pilot will no longer allow funding for the wheelchairs while appeals are adjudicated, leaving many beneficiaries without assistance and less able to live independently.
“Some of the most vulnerable people in our society, seniors and people living with physical disabilities, will face delays in receiving power wheelchairs or won't get them at all,” Wilson said.
The pilot, which was repeatedly delayed from an initial Jan. 1, 2012 start date because of provider and supplier concerns, has been “significantly modified” to address their objections, according to CMS documents.
Changes from the original design included allowing suppliers to submit the prior authorization request instead of the treating physician because of concerns that providers are unfamiliar with the process.
A CMS spokesman did not respond to questions about the AAH concerns.
However, the CMS plans “extensive education and outreach” before and during the pilot to physicians, practitioners, suppliers and beneficiaries, including a series of conference calls.
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