Kay E. Koch, OTR/L, ATP – Rehab Team Supervisor
The van Halem Group, a division of VGM
Medicare requires a home assessment when providing manual and power wheelchairs. The requirements are a bit different depending on the chair that is being provided, but it is recommended a standardized approach to the home assessment and the home assessment documentation be part of the supplier’s process when providing mobility.
The home assessment for a manual chair can be done by completing a home visit or indirectly based upon information provided by the beneficiary or their designee. The information needs to address issues like the surfaces on which the manual wheelchair will be used, the physical layout of the home and if there will be any obstacles to propelling the chair in the home. Adequate assess to between the rooms and maneuvering space in the home needs to be documented. This assessment has to be fully addressed and documented in the medical record, therapist evaluation or the supplier records.
Medicare requires that the supplier visit the home at or before delivery and verify that the patient can adequately maneuver the PMD in the home. Documentation needs to address the home’s physical layout, including doorway widths, any doorway thresholds and the surfaces on which the power chair will be used. Measurements of the doorways should be included along with the number of steps, if any, to access the home and plans, if any, for a ramp or alternate access to the home. If the home is two stories, it should be documented that the power chair can be used on the first floor to accomplish all the patient’s MRADL’s.
Make the written report of the home assessment covering all the items.
Most suppliers create a form that is used for both power and manual chairs to ensure that the documentation is complete and meets the Medicare requirements. The home assessment can be completed by the RTS/ATP or a technician.
There is no requirement for a supplier to perform a new PMD home evaluation to reassess a beneficiary’s home in the event that a beneficiary changes residence. Medicare would not start a new capped rental period if the new residence will not accommodate the PMD the beneficiary is currently renting and a different base (same HCPCS code) is required. If the supplier elects to provide a different wheelchair base (different HCPCS code), a new signed and dated detailed product description (DPD) is needed, but a new face-to-face examination (F2F) or seven-element order (7EO) is not needed.
If a beneficiary with a PMD moves and their new home will no longer accommodate the PMD, Medicare will not pay for a new wheelchair.
Medicare covers a replacement only if an item is lost, stolen, irreparably damaged or reaches the five-year reasonable useful lifetime. A police report would be required if the item was stolen. The damage to the wheelchair must be documented and cannot be malicious.
Medicare covers a different item only if there is a change in the beneficiary’s medical condition. This change in condition would need to be documented in the medical records.