Provider Notice issued 05/22/07

Clarification of Right of Nursing Facility Residents to Motorized Wheelchairs

On March 28, 2007, the Department issued a provider notice to all nursing facilities regarding Jackson v. Maram, No. 04-C-174 (N.D.III), which required nursing facility residents who are eligible for Medicaid to be evaluated and assessed for motorized wheelchairs, and be provided with motorized wheelchairs when medically necessary.

This notice is being distributed to clarify three areas involving completion of the Motorized Wheelchair Evaluation Form.

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 Motorized Wheelchair Evaluation Form.  This means that after the initial form is completed at admission, the evaluation form should be completed again at least quarterly when the resident’s Plan of Care is updated.  If a resident has been provided with a motorized wheelchair, further evaluation is not required. 

The evaluation form does not need to be completed at admission for persons who are Medicaid-pending.  Once Medicaid eligibility is determined, the resident should be evaluated during the next quarterly Plan of Care.

Evaluation forms completed initially at admission and quarterly are not to be submitted to the Department of Healthcare and Family Services.  For residents who may be eligible for a wheelchair, the nursing facility must arrange for a full wheelchair assessment by an independent qualified professional.  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.

If the physician prescribes a custom motorized wheelchair – meaning a wheelchair that must be built, in whole or 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 (DME) supplier of the resident’s choice who is a provider enrolled under the Medical Assistance Program.  The DME supplier will in turn send a prior approval request along with the physician’s prescription to the Department of Healthcare and Family Services.

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.

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.

A copy of all completed evaluation forms must be available for review by the Department of Public Health for compliance.

If you have any questions concerning this notice, contact the Bureau of Long Term Care at 217-524-7245.

Theresa A. Eagleson, Administrator

Division of Medical Programs