Custom Durable Medical Equipment Stephanie Harrington PT MPT

Custom Durable Medical Equipment Stephanie Harrington, PT, MPT, ATP Meredith Ford, PT, DPT, C/NDT

Objectives y Identify and evaluate for when DME is required y Recognize custom durable medical products in the field y Understand y Discuss recent advances in custom DME related insurance nuances 2

Wheelchairs Considerations for Pediatric Care y Patient mobilization limitations § Does the patient have strength, endurance, range of motion or muscle tone limitations? § Does the patient have the capacity to independently propel themselves? § Does patient have cognitive ability and safety awareness in order to control a power chair? y Type of transfer – How to get in and out § Can the patient ambulate with assistance or by self? § Is a sliding board required for transfer? y Frame transportation § What type of vehicle does the patient have? § Is there an installed lift system? y Account for growth in pediatric cases § Insurance requirement for 20% growth in seat width and depth § Required to account for approximately 3 -5 years of equipment use 3

Wheelchairs Manual Products y Tilt in Space Chairs § Accommodate tone abnormalities, posture deformities (scoliosis), weakness, respiratory and cardiac impairments - Freedom® NXT, Quickie® Iris y Upright Manual Chairs § Use when patient has good sitting balance, self propulsion, possible backup for a power chair § Folding chairs - Quickie® 2 § Rigid chairs – lighter and more energy efficient - Ti. Lite® Aero Z, KI Little Wave Clik 4

Wheelchairs Power Assist Products y Accessories for Manual Chairs § Smart Drive - Easy on and off Compatible with folding and rigid frames Must trial prior to ordering 11 Pound drive § Emotion Wheels - Compatible with folding and rigid frames - Drive on wheels – 20 pounds/wheel 5

Wheelchairs Power Products y Wheel Type § Front wheel drive – indoor and outdoor use § Mid wheel drive – use in tight or confined spaces § Rear wheel drive – used in a variety of environments y Drive Type § If there is a functionally controlled movement, the patient can drive. § Hand, head array, Sip n Puff, Micropilot y Power Seat Functions § Power tilt indication - Does the patient have the ability to perform a pressure relief by themselves? § Power seat elevator indication – Can the patient perform a level transfer by themselves? § Power recline indication – Does the patient struggle with prolonged upright sitting? § Power elevating leg indication – Is the patient unable to lift legs or has risk of swelling? § Power stand indication – Is the patient a client for standing and can perform an independent level transfer? 6

Seating Considerations for pediatric care y Variety of seating options for postural deficits § Cushions - Pressure relief, patient positioning, ease of use (ROHO®) § Sport backs – Mild postural deficits, weakness or tone abnormalities (Jay® 3™) § Solid seating – Moderate postural deficits, ability for customization (Freedom Seating System) § Custom molded – Most severe postural deficits: scoliosis, pelvic obliquities, Gibbus deformities (Contour-U) y Seating options on stroller are typically ‘off the shelf’ y Wheel chair seating is more readily customized y Insurance will not pay for seating system changes within 6 months of equipment delivery 7

Strollers Considerations for pediatric care y Tilt in Space and/or Recline § Consider when tone abnormalities, weakness, posture deformities, respiratory or cardiac deficit, or endurance impairments are present. § Is there a need for medical equipment transportation? Most products are capable for transport. § Zippie® Voyage™, Kimba® Neo y Upright § Typically used when patient is unsafe in wheelchair – behavioral issues, cannot physically or is not cognitively aware to propel wheelchair. § Convaid EZ Rider 8

Bath and Toilet Considerations for pediatric care y Imperative that there is an evaluation of the home environment – Q&A § Discussion at time of evaluation to assess: - Is the patient in own bath area or sharing with others? - Layout and type of bath/shower equipment? y Patient capabilities § Is the patient capable of independent transfers? § Does patient demonstrate good head and trunk control and sitting balance? y Bath Equipment § Rifton® Bath Chair § Drive Tub Transfer Bench § Tub. Buddy™ Transfer System y Toilet Equipment § Rifton® HTS § Columbia™ Medical Commode Chair 9

Beds Considerations for pediatric care y Hospital Bed § Does the patient require head and foot elevations due to a medical condition? - Respiratory or cardiac deficit, impaired oral-motor function, seizures § Allows for head and foot articulation and/or bed height adjustment y Enclosed Safety Bed § Use indicated when patient is at risk to themselves or others. § Lack of cognitive or safety awareness to stay in bed – climb, scoot, roll out of bed. y Combination Hospital/Enclosed Options 10

Car Seats Considerations for pediatric care y Patient Limitations § § y Consider postural limitations in seat selection Commercial restraint has been out grown Impaired safety awareness – patient able to unbuckle self Weight requirements dictate equipment selection Vehicle Requirements and Accessibility § Year of manufacture and installed safety equipment § Seat requires proper securing – top tether and seat belt y All adaptive car seats/beds/booster seats must be installed by a technician certified in car seat installation 11

Car Seats Considerations for pediatric care y Weight Requirements § § § § The Hope Car Bed ™ by EZ Tether – 4. 5 -35 lbs Traveler Plus Car Seat by Snug Seat – 22 -105 lbs Recaro Performance. Sport – 20 -120 lbs The Roosevelt™ Car Seat by EZ Tether – 35 -115 lbs Spirit™ Car Seat by Columbia™ – 25 -130 lbs The Churchill™ Backless Booster by EZ Tether- 65 -175 lbs E-Z-On® Vests by EZ On Products – 20 -168 lbs The Jefferson ™ Car Seat by Merritt Mfg. – 7. 5 – 40 lbs 12

Standers, Gait Trainers, Walkers Considerations for pediatric care y All accessories require insurance justification y Must have growth built into system y Recommend trial prior to ordering y Insurance denies simultaneous Stander and Gait Trainer at same time y Insurance will not allow for changes or replacement within 6 months of equipment delivery 13

Standers, Gait Trainers Commercial Products y Standers § Supine – Rifton®, Squiggles, Superstand, Zing™ § Prone – Rifton® Prone, Lecky Prone. Stander, Jenx § Sit-to-Stand – Bantam™, Evolve™ y Gait Trainers § § Rifton® Pacer Kid. Walk Up n Free™ Grillo 14

Other Equipment Considerations for pediatric care y Collars § Provide support for anterior neck muscle control § Adaptive to multiple equipment platforms y Adaptive tricycles § Not usually an insurance covered expense – charity and supplemental funding needed y Feeding, positioning, activity chairs 15

Insurance Considerations Medicaid Nuances I y Custom manual and power wheelchairs/adaptive strollers § Requires PT or OT present with the Assistive Technology Practitioner (ATP) at the time of any new custom evaluation or major modification § Requires the same ATP to be present at time of equipment delivery y No payment for changes to current or new equipment until 6 months post equipment purchase y Eligibility for seat elevator on a custom power wheelchair § Must be able to preform level transfers or be able to perform level to unleveled surfaces with the use of a seat elevator y Adaptive car seats and booster seats § Pays based on medical or functional need § Not based on weight or height limits § Must be installed by vendor provided certified technician 16

Insurance Considerations Medicaid Nuances II y Adaptive strollers § Must be age appropriate § Must have growth options § Must have firm seating system y Standers and Gait trainers § Requires justification for each accessory y Power beds § Patient must be able to independently physically transfer high-low function as well as operate remote § Head and foot articulation § Must be medical justification for this feature - Seizures, cardiac, respiratory, oral motor justifications 17

Insurance Considerations Private Key Points y Therapist Presence § PT/OT not required for custom manual wheelchair or stroller evaluation § PT/OT must be present for Group 3 or higher custom power wheelchair evaluation y Insurance Coverage § Transit options and trays are typically not covered § May not cover bath/potty, car seat, and stander plan dependent coverage 18

Insurance Considerations Alternate Funding Sources y Medicaid Waiver Program (MDCP and CLASS) y Must have Medicaid denial first y MDCP – Family must call to get 3 quotes for item requested y Texas Department of Assistive and Rehabilitative Services (DARS) y Charity Program y Texas ELKS y Junior League 19

Durable Medical Equipment Stephanie Harrington, PT, MPT, ATP Meredith Ford, PT, DPT, C/NDT Questions? 20