Medicare mandates prior authorization for powered wheelchairs in 7 states

Starting Sept. 1, prior authorizations will be required for fulfillment of power wheelchair claims under Medicare in California, Florida, Illinois, Michigan, New York, North Carolina, and Texas. But some healthcare organizations argue that physicians have no standard clinical template for documenting the need for mobility equipment, creating concerns that legitimate needs will be denied because of poor documentation support.

Senior homecare organizations are worried that if legitimate wheelchair claims are denied or delayed, seniors with mobility challenges who could have remained at home may have to seek mobility assistance elsewhere.

“This decision by CMS is very disappointing,” said Tyler Wilson, president and CEO of the American Association for Homecare in a statement. “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.”

CMS’ new policy is intended to reduce fraud but may end up indavertently jeopardizing elder care, Wilson said. "We support efforts to prevent fraud and abuse, and fixing the broken documentation system will help. Let's put in place a system that prevents fraud but also allows the most vulnerable people in our society to receive the mobility assistance they need to remain safe and live independently in their homes."

Topics: Executive Leadership , Medicare/Medicaid , Regulatory Compliance