Earlier this week, The ALS Association filed comments with the Centers for Medicare and Medicaid Services (CMS), urging the agency to provide Medicare coverage for seat elevation systems in power wheelchairs since these systems are a medical necessity for people living with ALS.
A decision on the National Coverage Determination (NCD) is expected in February 2023.
Seat elevation not only enhances quality of life and promotes independence; it also helps reduce harms associated with ALS.
Yet, results from an ALS Focus survey indicated that only 4 percent of respondents who needed power wheelchairs with seat elevation said that their insurance covered part of the cost.
Members of our public policy team explained the fight to make sure seat elevation is covered on a recent episode of Connecting ALS. A transcript of that conversation has been edited for brevity.
What can you tell us about the new campaign to make sure that Medicare covers seat elevation for complex wheelchairs?
This is an issue that we've actually been working on for a very long time. We've been pushing Congress and the administration to make this happen because it's so critically important to people living with ALS. At this moment, Medicare does not consider seat elevation to be medically necessary, and therefore they do not provide insurance coverage. Now, if you have private insurance or you have VA coverage, you might be able to get seat elevation covered, but Medicare is a really important payer and they say it isn't medically necessary. We believe that it is, and Medicare has recently issued a call for comment on national coverage determination, and that's what they're basically asking people is what do you think? Should we cover this? Our answer is 100 percent, yes, Medicare should cover seat elevation immediately, and we're doing a lot to make that happen.
We give comments directly to CMS, and then we also encouraged members of Congress to send letters to CMS. So we have kind of a two tiered plan, and maybe the third tier of that was we work with a lot of other national organizations.
So we're working with a big coalition called the Independence Through Medicare and Medicaid Coalition, and their job is to encourage Medicare and Medicaid to pay for services, devices, and the kind of care that enables people to be independent. We feel that seat elevation is one of those very important things that Medicare should cover, because it really is medically necessary, and of course, it's critically important to people being independent and being able to safely transfer from their wheelchairs and complete activities of daily living, such as eating, reaching the refrigerator, the stove, things like that. So that's why we're really excited about this opportunity to put pressure on the Medicare program to do the right thing.
Listen to the full episode at ConnectingALS.org.
Download our comments to CMS here.
