2/13/2014 12:00:00 AM
Major Problems with New Connecticut Medicaid Regulation: Implementation of Rushed “Customized Wheelchair” Regulation Must Be Delayed
Immediate Delay Needed
The Department of Social Services published Regulation 13‐01 on January 31, 2014 to implement major changes to the provision of “customized wheelchairs” within the Medicaid program. These specialized wheelchairs are used by a small group of children and adults with the most significant disabilities.
While NCART is supportive of adding appropriate improvements and safeguards to the customized wheelchair provision process, this major overhaul is being unnecessarily rushed to implementation on March 1, 2014. There has not been opportunity for prior public comment nor has adequate time been allowed for the education of physicians, therapists, Medicaid members, and providers. There is no emergent need that justifies the Department’s rush to implementation and doing so creates significant risks to the most fragile of Medicaid members.
Given the significance and extent of the proposed changes implementation must be delayed until at least June 1, 2014 to allow impacted physicians, therapists, Medicaid members, and providers to share questions and concerns and collaborate with the Department on needed clarifications and changes.
Read 13-01 Legislation here.
Concerns and Questions Requiring Resolution
There are many significant concerns and questions regarding the 30 pages of new policies and processes in Regulation 13‐01 that require resolution before moving ahead. These include the following:
- There has been insufficient education and outreach to physicians, therapists, Medicaid members,and DME providers on the new rules and processes being implemented. Given the significance ofthe changes there needs to be a sufficient period of time for the regulation details to be adequatelydisseminated. This is needed so that new policies, processes, and forms can be understood andassimilated into clinical and business practices. Once the regulations have been publicly reviewedand finalized, an educational period of 90 days should be provided before changes go into effect.
- The regulation requires customized wheelchairs to “include refurbished parts and components tothe maximum extent practicable” and goes further to put any liability on the DME provider. There is no precedent of any federal or state health care plan requiring this for customized wheelchairs. The concept is fraught with liability and safety risks on so many fronts for the state, the Medicaid member, the DME provider, and the DME manufacturer. Issues include the fact that using “refurbished” parts may void the manufacturer’s warranty and put anyone involved in such a process at high risk for being sued. This is totally unacceptable and no DME provider will take on this potential major liability. In addition the regulation does not describe how these items, if provided, would be accessed or paid for. This information along with other financial details must be identified and incorporated into an analysis of the total costs and feasibility of a “refurbished equipment program”. (See Sec. 17b‐262‐1032 (b)) and (See Sec. 17b‐262‐1036 (f))
- The regulation requires the customized wheelchair to remain the Department’s property after delivery to the Medicaid member and also indicates the Department will not be liable for injuries or damages. This raises a host of legal questions regarding Medicaid member rights, the DME provider’s liability, the state’s liability, the manufacturers’ warranties, and other areas. These questions need to be fully vetted before such policy can be responsibly implemented. (See Sec. 17b‐ 262‐1036 (e))
- The regulation limits the important inclusion of a credentialed DME technology professional in key aspects of the assessment process. The concept of an interdisciplinary team controlling the provision of customized wheelchairs is fully supported. However, the customized wheelchair team approach considered best practice today includes a RESNA credentialed Assistive Technology Professional (ATP) employed by the DME provider. The ATP is the recognized technology equipment expert who works with the physician, therapist, Medicaid member, and/or caregiver to match the Medicaid member’s identified medical and functional needs to the most appropriate technology solutions. The ATP is also the person that assembles and provides simulation equipment as needed to evaluate potential mobility and seating options. Accordingly, the ATP should be allowed to participate in the initial assessment process. (See Sec. 17b‐262‐1025 (d) and (g) (2)) and (See Sec. 17b‐262‐1030 (b))
- The regulation establishes standards for coverage that do not include consideration of a Medicaid member’s functional needs and abilities outside the home environment. Both the Medicaid member’s medical and functional needs must be considered and this consideration must include all environments that the Medicaid member encounters on a routine basis, including community settings outside of the home.
- The regulation requires all Medicaid members be tried in “standard wheelchairs, standard wheelchairs with seating, and other categories of DME”. What does this mean for individuals that have a documented high level disability and based on their medical condition and functional abilities it is patently obvious that such attempts are unnecessary and would be stressful for the Medicaid member? (See Sec. 17b‐262‐1032 (a) (2))
- The regulation introduces 5 separate payment rate possibilities but does not provide the needed definitions for some of them. The payment rates have a direct impact on the variety and quality of equipment and related services that can be provided. These must be fully explained by the Department and understood by the providers. (See Sec. 17b‐262‐1035 (b)) (2‐10‐14)
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The National Coalition for Assistive and Rehab Technology (NCART) works to ensure individuals with disabilities have appropriate access to complex rehab technology (individually configured wheelchairs, seating systems, and other adaptive equipment) and related services. For additional information visit www.ncart.us or email info@ncart.us.