Custom Durable Medical Equipment Stephanie Harrington, PT, MPT,

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

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

Wheelchairs Considerations for Pediatric Care 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? 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? Frame transportation What type of vehicle does the patient have? Is there an installed lift system? 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 Tilt in Space Chairs Accommodate tone abnormalities, posture deformities (scoliosis), weakness, respiratory and cardiac impairments - Freedom NXT, Quickie Iris 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 - TiLite Aero Z, KI Little Wave Clik 4

Wheelchairs Power Assist Products 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 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 Drive Type If there is a functionally controlled movement, the patient can drive. Hand, head array, Sip n Puff, Micropilot 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 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) Seating options on stroller are typically ‘off the shelf’ Wheel chair seating is more readily customized Insurance will not pay for seating system changes within 6 months of equipment delivery 7

Strollers Considerations for pediatric care 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 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 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? Patient capabilities Is the patient capable of independent transfers? Does patient demonstrate good head and trunk control and sitting balance? Bath Equipment Rifton Bath Chair Drive Tub Transfer Bench TubBuddy Transfer System Toilet Equipment Rifton HTS Columbia Medical Commode Chair 9

Beds Considerations for pediatric care 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 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. Combination Hospital/Enclosed Options 10

Car Seats Considerations for pediatric care Patient Limitations 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 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 Weight Requirements The Hope Car Bed by EZ Tether – 4.5-35 lbs Traveler Plus Car Seat by Snug Seat – 22-105 lbs Recaro PerformanceSport – 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 All accessories require insurance justification Must have growth built into system Recommend trial prior to ordering Insurance denies simultaneous Stander and Gait Trainer at same time Insurance will not allow for changes or replacement within 6 months of equipment delivery 13

Standers, Gait Trainers Commercial Products Standers Supine – Rifton , Squiggles, Superstand, Zing Prone – Rifton Prone, Lecky ProneStander, Jenx Sit-to-Stand – Bantam , Evolve Gait Trainers Rifton Pacer KidWalk Up n Free Grillo 14

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

Insurance Considerations Medicaid Nuances I 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 No payment for changes to current or new equipment until 6 months post equipment purchase 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 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 Adaptive strollers Must be age appropriate Must have growth options Must have firm seating system Standers and Gait trainers Requires justification for each accessory 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 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 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 Medicaid Waiver Program (MDCP and CLASS) Must have Medicaid denial first MDCP – Family must call to get 3 quotes for item requested Texas Department of Assistive and Rehabilitative Services (DARS) Charity Program Texas ELKS Junior League 19

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