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17.3.17.2 Manual Wheelchairs
Manual wheelchairs may be noncustom DME, or they may be custom DME or they may be noncustom if they are modified or in any way customized to the individual client's needs.
The CSHCN Services Program may reimburse providers for a manual wheelchair when the equipment is medically necessary for any nonambulatory client enrolled in the CSHCN Services Program. The physician or therapist is responsible for maintaining documentation indicating nonfunctional ambulation, situations where ambulation is contraindicated, or when ambulation is not adequate for independently accessing the community. Conditions that may debilitate a client to the point that ambulation would be detrimental to the client's health (e.g., cancer, cystic fibrosis, cardiac conditions, etc.) may also be considered.
Eligible clients may receive a manual wheelchair in addition to a power wheelchair or travel chair. The manual chair is purchased as a backup; therefore, cost and accessories should be minimal. Aside from having a manual wheelchair backup for a power wheelchair, the CSHCN Services Program does not authorize purchase of more than one form of mobility equipment per eligible client.
No more than one manual wheelchair may be authorized in a 3-year period without documentation of medical necessity for a second or replacement wheelchair. If the wheelchair is stolen or damaged in an accident before it is scheduled to be replaced, a police report must be submitted with the authorization request to justify replacing it.
Rental must be considered for short-term needs when the total rental cost is expected to be less than the purchase price. If public funds were used to pay for a wheelchair within the last 3 years, specific justification is required to prior authorize a new chair.
If an immediate need for a wheelchair is indicated in the CSHCN Services Program Wheelchair Seating Evaluation Form, and the CSHCN Services Program has approved a wheelchair, DME providers are required to provide a loaner wheelchair free of charge until the approved equipment is delivered to the client.
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