PreviousMaine Care will provide coverage of power-operated vehicles that may be used as wheelchairs when they are determined to be medically necessary. A written document must be submitted that indicates the POV can freely pass through all entryways without the need of modification. It is the responsibility of the provider to submit the documentation indicating that the necessary modifications or structural changes have occurred prior to the request for prior authorization. If the POV is being requested for a member residing in a Nursing Facility or similar setting where there is continuous supervision, the requesting provider needs to document the member's medical necessity to be independently mobile beyond what can be provided by staff.
A POV will be denied as not medically necessary when it is needed primarily for use outside the home or for recreational or leisure activities. Members are limited to one (1) POV every 3 years and cannot upgrade to a power wheelchair until the three (3) years have lapsed.
In addition to meeting all of the criteria for a standard wheelchair, the following additional criteria must be met:
A specialist in physical medicine, orthopedic surgery, neurology, or rheumatology must provide an evaluation of the member's medical and physical condition and write a prescription for the vehicle to assure that the member requires the vehicle and is capable of using it safely. The Department may request an evaluation by an occupational therapist and/or physical therapist in place of these specialists. The documentation should also include a statement indicating that the member can safely transfer in and out of the POV and has adequate trunk stability to safely ride in the POV. If it is determined that such a specialist is more than one (1) day's round trip from the beneficiary's home, or the member's condition precludes such travel, a prescription from the beneficiary's physician or PCP is acceptable.
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