Provider Notice issued 03/28/07

Right of Medicaid-eligible Nursing Facility Residents to Motorized Wheelchairs

As required by the United States District Court in Jackson v. Maram, No, 04-C-174 (N.D. III.), Medicaid-eligible nursing facility residents must be provided with wheelchairs when medically necessary. Nursing facilities that serve Medicaid-eligible individuals are responsible for ensuring that these residents are evaluated for, assessed for and provided with wheelchairs. Upon a determination of medical necessity, this notice sets forth the following procedures you must follow to ensure this right is fulfilled.

1. Within 30 days of admission, and as part of each Medicaid-eligible resident’s Plan of Care, a member of the nursing facility’s staff must complete the attached evaluation form. This evaluation will determine whether the resident may be eligible for a wheelchair. It must be made part of the resident’s Plan of Care. The staff member completing the evaluation must be competent to complete this form and familiar with the resident he/she is evaluating. 

• For residents who may be eligible for a wheelchair, the nursing facility must arrange for a full wheelchair assessment by an independent qualified professional. A “qualified professional” is 1) an occupational therapist, physical therapist or other health care professional who is currently licensed by the State of Illinois and who has at least two years experience in rehabilitation seating and positioning, 2) an occupational therapist, physical therapist or other health care professional who is currently licensed by the State of Illinois and who has received at least five hours of training in rehabilitation seating and positioning within the past year, or 3) a health care professional who is certified by the Rehabilitation and Assistive Technology Society of North America (RESNA) as an Assistive Technology Practitioner, a Rehabilitation Engineering Technologist or an Assistive Technology Supplier.

In the initial evaluation, the facility will ask the resident if he/she consents to a full motorized wheelchair assessment. If the resident does not consent, the nursing facility need not take further action. However, residents may change their mind at any time thereafter, after which the nursing facility must provide a full assessment. 

1. If this assessment recommends a motorized wheelchair for the resident, the nursing facility must arrange for, or otherwise make sure that, the assessment is provided to a physician for appropriate follow-up. 

2. If the physician prescribes a custom motorized wheelchair – meaning a wheelchair that must be built, in whole are in part for an individual resident – the nursing facility will submit, on the resident’s behalf the prescription and the assessment to the Durable Medical Equipment Supplier of the resident’s choice who is a provider enrolled under the Medical Assistance Program who in turn will send a prior approval request along with the physician’s prescription to the Illinois Department of Healthcare and Family Services. 

3. If the physician prescribes a non-custom motorized wheelchair – meaning a wheelchair that is not built for a specific resident – then the nursing facility must provide the motorized wheelchair for the resident. 

4. If the physician does not prescribe a motorized wheelchair, the nursing facility needs to obtain from the physician written reasons for this action and provide them to the resident. These reasons must be legible and sufficiently descriptive to allow the resident to understand the reasons for the denial. If the nursing facility fails to obtain such a statement from the physician, the facility must submit the assessment to another physician.

Nursing facilities that fail to meet the above responsibilities are subject to sanctions, including fines and decertification.

Please direct any questions to the Department of Healthcare and Family Services Healthcare Benefit Hotline at 1-800-226-0768.