History in the Making- CMS Expands Coverage of Power Seat Elevation Systems

In 2020, I was eligible for a new power wheelchair. I worked tirelessly to make the medical necessity argument for a power seat elevator. My private insurance carrier denied me. I spent months appealing only to receive the dreaded letter titled “Final Adverse Determination of Benefits.”

My insurance provider essentially told me that I had no more avenues for appeals, and I would have to pay nearly $1,500 out-of-pocket for a seat elevator, which has now greatly improved my independence and quality of life.

I am now able to raise myself up to cook food on the stove safely, brush my teeth at the sink, and safely transfer to my bed, among numerous other benefits. Most importantly, the ability to perform these daily functions independently reduces my risk of secondary complications, such as pressure sores and broken bones due to falls from transferring to and from uneven services.

Life was going to be tremendously more complicated without this addition. I have given myself the middle name, “Pleasantly Persistent.”

After several weeks I received a written letter from my insurance carrier explaining that they now “magically” found that my seat elevator was medically necessary for my diagnoses. Really? They even put a disturbing and common line in the letter stating, “This is not a precedent.” This enraged me!

Why did I have to fight so hard to survive while trying to thrive in life and make a difference in my advocacy work? I developed a laser focus on this issue and started reaching out to people, legislators, and organizations nationwide.

I soon realized this was a national issue and needed attention immediately. After working with the Reeve Foundation, they kindly invited me to be part of the I.T.E.M. Coalition (The Independence Through Enhancement of Medicare and Medicaid). The I.T.E.M. Coalition is a national consumer and clinician-led coalition comprised of advocates, doctors, lawyers, organizations, PT’s, OT’s and more advocating for access to and coverage of assistive devices, technologies, and related services for persons with injuries, illnesses, disabilities, chronic conditions of all ages.

I accepted and the work started. We spent countless hours on phone calls, drafting briefs, writing clinical papers, advocating for change on Capitol Hill in a Congressional Briefing, to name a few.

Specifically, our focus has been to work with CMS (Medicare) to reclassify power seat elevators and standing power wheelchairs as durable medical equipment. Previously, they have been classified as luxury items, which is a joke. Many of us with significant disabilities and in power chairs need seat elevators to improve our quality of life.

There are no words to express my elation with the decision CMS made to expand Medicare Coverage for seat elevators for power wheelchairs on Tuesday, May 16, 2023.  Effective immediately!

Here is a brief summary of CMS’s decision:

• Seat elevators are no longer a convenient item and, in fact, “primary medical in nature."

• Seat elevation systems are now to be covered under DME if it is deemed reasonable and necessary for beneficiaries who, due to a mobility impairment, need seat elevation in a Complex Rehab Technology (CRT) power wheelchair. 
  

• Coverage for all power wheelchairs includes:

• • Seat elevation to perform all transfers or to improve reach in performing MRADL’s (think reaching, raising up to the bathroom, raising up to cook, etc. -- anything involving reach)
  • More than that, they will also cover seat elevation if it assists caregivers helping patients transfer.

This is a proud day in history and an incredible strategic effort on so many people's behalf.