Rep. Brian Fitzpatrick (R-Pa.) and Rep. Debbie Dingell (D-Mich.) have penned another “Dear Colleague” letter asking the Centers for Medicare & Medicaid Services (CMS) to open a coverage determination for power standing on power wheelchairs.

“Please contact your U.S. representative today and urge them to sign on to the Dingell/Fitzpatrick Congressional sign-on letter urging CMS to promptly open the NCA [national coverage analysis] and public comment period regarding coverage for standing systems in power wheelchairs,” the National Coalition for Assistive & Rehab Technology (NCART) told stakeholders in a Sept. 17 bulletin.

The Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, one of the industry leaders on the power standing issue, noted that the original request for coverage determination “was submitted in September 2020. The absence of Medicare coverage for these systems leaves many beneficiaries without access to critical technology that can significantly improve their health outcomes and quality of life. Four years is far too long for Medicare beneficiaries to be forced to wait for CMS to initiate this important coverage analysis.”

The ITEM Coalition has provided an online system for stakeholders to contact their representatives to ask them to sign onto the Dingell/Fitzpatrick letter.

The deadline for members of Congress to sign onto the letter is Fri., Sept. 27.

Four years without progress or a timeline

Dingell and Fitzpatrick, co-chairs of the Bipartisan Disabilities Caucus, sent a similar NCA-request letter to CMS Administrator Chiquita Brooks-LaSure in July 2023.

Sept. 15 marked the four-year anniversary of the filing of the original coverage determination request.

Complex Rehab Technology (CRT) advocates simultaneously requested coverage determinations for power seat elevation and power standing four years ago. CMS began the seat elevation coverage determination in August 2022, and then issued its final coding, benefit category, and payment determinations for seat elevation on power wheelchairs earlier this year.

But CRT stakeholders continue to wait for CMS to begin the power standing coverage determination process.

In August 2022, when CMS called for its public comment period for seat elevation, it said, “The benefit category and coverage of standing systems will be considered at a later date,” without providing a timeline.

In response, the ITEM Coalition said it was “seriously concerned and disappointed with CMS’s decision to delay the consideration of evidence for power standing systems, which were included as a connected benefit in the original September 2020 Request for Reconsideration of the National Coverage Determination for Mobility Assistive Equipment. After nearly two years of waiting for this NCA to be opened, it is unacceptable that CMS has taken this course of action, and the ITEM Coalition implores CMS to open an NCA for power standing systems at the earliest possible opportunity.”

When CMS released its proposed seat elevation coverage decision in February 2023, the agency said, “Because the evidence base for power seat elevation wheelchair equipment is distinct from that of power wheelchair standing equipment, it is outside the scope of this analysis. CMS will consider these items in a separate future National Coverage Analysis.”

Industry stakeholders still have no timeline for the NCA.

Power standing advocates contend that power standing on power wheelchairs enables power chair riders to independently move from a seated position to a standing one, without requiring caregiver assistance and without requiring riders to transfer out of their power chairs. That change of position can provide crucial weight shifting and pressure relief, and can also support mobility-related activities of daily living that are easier and safer to perform from a standing position, the ITEM Coalition noted in its advocacy letter.

Standing can also provide a range of health benefits, from improved joint mobility and muscle tone, to improved respiration and cardiovascular functions, reduced spasticity and muscle contractures, and beneficial changes in weight bearing, which can improve bone density and strength, the ITEM Coalition added.