Question about Wheelchairs and DME
Kelly Della Rocca PT, MA

QUESTION:
If a person is temporarily paralyzed but is expected to get better and you think they need an electric chair now but they prognosis looks like they will be able to walk in a month or so...could you rent an electric chair with the option to buy that or trade it in on a manual if she upgraded her functioning...would Medicaid cover the rental cost of an electric and then buy her manual or electric chair depending on whether she regained her function or not? 
ANSWER:
Just to keep in mind: because Medicaid varies by state, this answer will only be applicable in Missouri.  
In order for an item to be termed durable medical equipment, it must meet the following criteria:
1. Can withstand repeated use
2. Is primarily and customarily used to serve a medical purpose
3. Is not useful to a person in the absence of injury/illness, and
4. Is appropriate for use in the home
Wheelchairs typically fit this description. Depending on other criteria, Medicaid will either purchase, rent, or rent to purchase wheelchairs for beneficiaries. Basically, a Prior Authorization Request (a form that the
patient's doctor fills out that says why the specific piece of equipment is necessary, and that lists the prognosis and the diagnosis) or a certificate of medical necessity, a.k.a. CMN (another form basically stating the same stuff as the prior auth. form) will need to be filled out and submitted to Medicaid. Medicaid will then look at that information and will decide if it's going to be less expensive to rent the equipment or to purchase it. They will then do whatever is the least expensive. Medicaid will replace equipment if there is a change in the recipient's condition that requires a new DME item. In order to replace equipment, though, a new prior auth. form or CMN will need to be submitted that describes the nature of the change of the patient's condition.

For the specific situation you're asking about, it sounds to me like, if Medicaid approves the prior auth. form or the CMN, then they might agree to rent a power chair because her need and prognosis, as stated on the prior auth. form/CMN, would indicate that she would not need it for very long. Then, another prior auth. form/CMN would need to be submitted for the next piece of equipment she needs (manual wheelchair, hemi-cane, etc...). They would then need to approve that request.

I hope this helps to answer your question. If you're interested in finding out more, I would encourage you to visit the Missouri Medicaid site. I found the following link of particular help:
http://manuals.momed.com/manuals/hyperlinkPage.render?idLinkParmName=dme

One other thing to keep in mind...Medicaid does not cover DME while a patient is 
(a) in a hospital (receiving either inpatient or outpatient services), or 
(b) in a nursing home. 
DME is included in the per diem provided for these institutions. However, a custom wheelchair or a power wheelchair would be paid for separate from the per diem rate if the prior auth. form/CMN is approved for these items.

QUESTION: … same question, but referencing Medicare instead of Medicaid:
ANSWER: 	
Wheelchairs are considered capped rental items by Medicare.  That is, Medicare actually rents wheelchairs to beneficiaries on a month-to-month basis for 13 months.  After that time, if the wheelchair is still medically necessary, the DME supplier transfers the title of the equipment over to the beneficiary, and the beneficiary then owns the wheelchair.  If a beneficiary needs a wheelchair for a short time only, and all correct documentation is obtained and shows medical necessity, Medicare would rent the chair to the beneficiary on a monthly basis until the beneficiary no longer needs the wheelchair.  At that time, the beneficiary would return the wheelchair to the DME supplier where he/she originally obtained the wheelchair.

Please let me know if you have any more questions.
Kelly Della Rocca PT, MA    9-15-2010