The Centers for Medicare & Medicaid Services (CMS) last week released an updated list of frequently asked questions (FAQs) about power wheelchair rentals.
CMS indicated that the questions had come from suppliers “regarding application of the power mobility devices medical policy and Centers for Medicare & Medicaid Services payment policy rules to rented power wheelchairs.”
Topics covered by the more than two dozen questions include change of beneficiary residence, breaks in service, repair and replacement, and short-term beneficiary use.
A question about breaks in service asks, “A power wheelchair (PWC) is being rented, and the beneficiary goes into a hospital and nursing home for an extended stay. The supplier elects to pick up the wheelchair. When the beneficiary is ready to go back home, would there be a problem with providing a different model wheelchair within the same HCPCS code?”
CMS’ answer: “If the supplier chooses to deliver a different model of PWC within the same code, a new detailed product description must be obtained. A new face-to-face (FTF) examination or seven-element order is not needed.”
Another question asks about a beneficiary moving to a new home: “If a patient with a PWC moves and their new home will no longer accommodate the PWC that they have, will Medicare pay for a new PWC?”
The answer: “No. Medicare covers a replacement only if an item is lost, stolen, irreparably damaged, or reaches the five-year reasonable useful lifetime. Medicare covers a different item only if there is a change in the beneficiary’s medical condition.”
More than a third of the questions in the document concern the controversial topic of repair and/or replacement of rental power chairs.
One question notes that power chairs, unlike many other capped rental items, are often used outside the home as well as inside. The question also references current Medicare policy of considering only a beneficiary’s “in-the-home” needs when determining eligibility for durable medical equipment: “Unique to power wheelchairs is the fact that beneficiaries often use the products outside the home as well as inside. This is generally not done with other capped rental items (e.g., hospital beds never leave the home). If a PWC is damaged outside the home, since that is not an approved use per Medicare, will the supplier be expected to repair the chair ‘at no charge’ during the rental period?”
“Yes,” the CMS response says, “the supplier is responsible for the repair. Statutory coverage of DME requires that it be needed for use inside the home. However, if that requirement is met, the item may be used outside the home. Portable oxygen, nebulizers, walkers, canes, crutches, POVs, manual and power wheelchairs are among the many (items), both rental and purchase, that are routinely used outside of the home setting. During the rental period, the supplier is expected to repair an item if the repair was related to damage that occurred either inside or outside the home. For purchased and rental items where the title has transferred, repairs are covered under the general repair rules.”
Several questions concerned “malicious damage or culpable neglect” by the beneficiary, and the supplier’s obligation to provide repairs in those cases.
“There can be no payment for the repair of rented items under any circumstances,” CMS says. “Reimbursement for repairs is included in the rental payments. If the supplier believes that a wheelchair repair is required because of malicious damage or culpable neglect by the beneficiary, the supplier can present the information to the durable medical equipment Medicare administrative contractor (DME MAC) for investigation. If the DME MAC, in consultation with the CMS, agrees that the beneficiary is responsible for the damage, the supplier can charge the beneficiary.”
To view the complete list of questions and answers, click HERE.