Question about Wheelchairs and DME

QUESTION:
If a person is termporarily paralyzed but is expected to get better and you think they need an electric chair now but they prognosis looks like they will be able to walk in a month or so...could you rent an electric chair with the option to buy that or trade it in on a manual if she upgraded her functioning...would Medicaid cover the rental cost of an electric and then buy her manual or electic chair depending on whether she regained her function or not?

ANSWER:
Just to keep in mind: because Medicaid varies by state, this answer will only be applicable in Missouri. 
In order for an item to be termed durable medical equipment, it must meet the following criteria:
1. Can withstand repeated use
2. Is primarily and customarily used to serve a medical purpose
3. Is not useful to a person in the absence of injury/illness, and
4. Is appropriate for use in the home

Wheelchairs typically fit this description. Depending on other criteria, Medicaid will either purchase, rent, or rent to purchase wheelchairs for beneficiaries. Basically, a Prior Authorization Request (a form that the
patient's doctor fills out that says why the specific piece of equipment is necessary, and that lists the prognosis and the diagnosis) or a certificate of medical necessity, a.k.a. CMN (another form basically stating the same stuff as the prior auth. form) will need to be filled out and submitted to
Medicaid. Medicaid will then look at that information and will decide if it's going to be less expensive to rent the equipment or to purchase it. They will then do whatever is the least expensive. Medicaid will replace
equipment if there is a change in the recipient's condition that requires a new DME item. In order to replace equipment, though, a new prior auth. form or CMN will need to be submitted that describes the nature of the change of the patient's condition.

For the specific situation you're asking about, it sounds to me like, if Medicaid approves the prior auth. form or the CMN, then they might agree to rent a power chair because her need and prognosis, as stated on the prior auth. form/CMN, would indicate that she would not need it for very long. Then, another prior auth. form/CMN would need to be submitted for the next piece of equipment she needs (manual wheelchair, hemi-cane, etc...). They would then need to approve that request.

I hope this helps to answer your question. If you're interested in finding out more, I would encourage you to visit the Missouri Medicaid site. I found the following link of particular help:
www.dss.mo.gov/dms/faq/pages/faqprov.htm
then you can click on "provider manuals" under the question "Why is the line often busy...". Then click on Durable Medical Equipment. I specifically found section 13 helpful.

One other thing to keep in mind...Medicaid does not cover DME while a patient is
(a) in a hospital (receiving either inpatient or outpatient services), or
(b) in a nursing home.
DME is included in the per diem provided for these institutions. However, a custom wheelchair or a power
wheelchair would be paid for separate from the per diem rate if the prior auth. form/CMN is approved for these items.

Please let me know if you have any more questions.

Kelly Della Rocca PT, MA