On August 16th the Accreditation Organizations received the notice below from CMS and we were asked to share the information with all suppliers.
Clarification Regarding Quality Standards and Accreditation Requirements for Ultra Lightweight Manual Wheelchairs
Ultra lightweight manual wheelchairs (code K0005 in the Healthcare Common Procedure Coding System) are highly configurable manual wheelchairs for highly active full time users. The ultra light weight manual wheelchairs require individualized fitting and optimal adjustments for multiple features that include axle configuration, wheel camber, and seat and back angles, in addition to ongoing critical support. These are services that are furnished by a Rehabilitative Technology Supplier (RTS); therefore, these items are considered complex rehabilitative wheelchairs subject to the requirements of section III of Appendix B of the DMEPOS Quality Standards.
All other lightweight manual wheelchairs are considered standard lightweight wheelchairs and are subject to the requirements of section I, rather than section III, of Appendix B which is the complex rehab section of the DMEPOS Quality Standards.
We believe that the vast majority of suppliers who furnish K0005 wheelchairs to Medicare beneficiaries are already in compliance with the Appendix B, section III requirements.
These requirements are effective for claims with dates of service on or after 03/01/2013. After that date, suppliers furnishing K0005 wheelchairs to Medicare beneficiaries that are not in compliance with these standards must come into compliance with these requirements or they will be required to stop furnishing these items to Medicare beneficiaries until these requirements are met.
Attachment: Appendix B of the DMEPOS Quality Standards
Appendix B: Manual Wheelchairs, Power Mobility Devices, and Complex Rehabilitative Wheelchairs and Assistive Technology
This appendix applies to Manual Wheelchairs, Power Mobility Devices (PMDs), and Complex Rehabilitative Wheelchairs and Assistive Technology. Manual wheelchairs include standard recliners, heavy-duty wheelchairs, standard lightweight wheelchairs, and hemi wheelchairs, armrests, legrests/footplates, anti-tipping devices, and other Medicare approved accessories. PMDs include power wheelchairs and power operated vehicles (POVs) and accessories. Complex Rehabilitative wheelchairs are Group 2 power wheelchairs with power options, Group 3 power wheelchairs and manual wheelchairs that can accommodate rehabilitative accessories and features (e.g., tilt in place),
I. Manual Wheelchairs
A. Intake & Assessment
In addition to Section II: Supplier Product-Specific Service Requirements, the supplier shall verify that seating, positioning and specialty assistive technology have been evaluated and documented in the beneficiary’s record.
B. Delivery & Set-up
Refer to Section II: Supplier Product-Specific Service Requirements.
C. Training/Instruction to Beneficiary and/or Caregiver(s)
Refer to Section II: Supplier Product-Specific Service Requirements.
D. Follow-up
Refer to Section II: Supplier Product-Specific Service Requirements.
II. Power Mobility Devices
A. Intake & Assessment
In addition to Section II: Supplier Product-Specific Service Requirements, the supplier shall verify that seating, positioning and specialty assistive technology have been evaluated and documented in the beneficiary’s record.
B. Delivery & Set-up
Refer to Section II: Supplier Product-Specific Service Requirements.
C. Training/Instruction to Beneficiary and/or Caregiver(s)
Refer to Section II: Supplier Product-Specific Service Requirements.
D. Follow-up
Refer to Section II: Supplier Product-Specific Service Requirements.
III. Complex Rehabilitative Wheelchairs and Assistive Technology
In addition to Section II: Supplier Product-Specific Service Requirements, the supplier shall:
1. Employ (W-2 employee) at least one qualified individual as a Rehabilitative Technology Supplier (RTS) per location. A qualified RTS is an individual that has one of the following credentials:
Certified Rehabilitative Technology Supplier (CRTS);
Assistive Technology Supplier (ATS) (discontinued 12/31/2008);
Assistive Technology Practitioner (ATP) (discontinued 12/31/2008);
Assistive Technology Professional (ATP) (effective 1/1/2009).
2. The RTS shall have at least one or more trained technicians available to service each location appropriately depending on the size and scope of its business. A trained technician is identified by the following:
Factory trained by manufacturers of the products supplied by the company;
Experienced in the field of Rehabilitative Technology, (e.g., on the job training, familiarity with rehabilitative clients, products and services);
Completed at least 10 hours annually of continuing education specific to Rehabilitative Technology; and
Able to program and repair sophisticated electronics associated with power wheelchairs, alternative drive controls, and power seating systems.
3. The RTS shall:
Coordinate services with the prescribing physician to conduct face-to-face evaluations of the beneficiary in an appropriate setting and include input from other members of the health care team (i.e., PT, OT, etc.);
Provide the beneficiary with appropriate equipment for trial and simulation, when necessary;
Maintain in the beneficiary’s record all of the information obtained during the assessment; and
Implement procedures for assembly and set-up of equipment as well as a process to verify that the final product meets the specifications of the original product recommendation approved by the prescribing physician.
4. If beneficiaries are evaluated in the supplier’s facility, the supplier shall:
Provide the beneficiary private, clean, and safe rooms appropriate for fittings and evaluations; and
Maintain a repair shop located in the facility or in close proximity or easily accessible from another location of the supplier, as well as an area appropriate for assembly and modification of products.
A. Intake & Assessment
In addition to Section II: Supplier Product-Specific Service Requirements, the supplier shall verify that seating, positioning and specialty assistive technology have been evaluated and documented in the beneficiary’s record.
B. Delivery & Set-up
Refer to Section II: Supplier Product-Specific Service Requirements.
C. Training/Instruction to Beneficiary and/or Caregiver(s)
Refer to Section II: Supplier Product-Specific Service Requirements.
D. Follow-up
Refer to Section II: Supplier Product-Specific Service
