Insight into a Wisconsin woman’s months-long wait to have her wheelchair repaired
It took months to repair her wheelchair, which is common in Wisconsin.
For years, disability advocates and people who use wheelchairs and other mobility devices have complained that Wisconsin laws make it unnecessarily difficult to repair their devices. But last year, the state legislature passed two bills that address the delays in the repair process.
Act 83 eliminates the requirement for prior Medicaid authorization and physician prescriptions for the repair of wheelchairs and complex rehabilitation technologies.
Law 182 increases the reimbursement rate for complex rehabilitation technology and accessories.
This is what you need to know about the new laws.
Why are wheelchair users experiencing repair delays in Wisconsin?
Since the COVID-19 pandemic, supply chain delays have contributed to longer wait times for repairs of wheelchairs and other mobility aids.
According to a 2023 report by the National Disability Rights Network, workforce cuts at manufacturing companies, slowed delivery of replacement parts, and a declining number of local repair shops have contributed to longer wait times. Advocates believe delays are caused at least in part by companies’ desire to maximize profits.
Users of mobility aids must therefore expect repair processes that can take weeks or months.
Before Act 83, Wisconsin’s authorization requirement also meant that a person had to get a prescription from a doctor and approval from Medicaid to have a wheelchair or scooter repaired, a process known as prior authorization.
The manufacturers stated that the process was lengthy and time-consuming.
More: She waited over a year for her wheelchair. In Wisconsin and elsewhere, this is normal.
How long does it take to pre-approve a wheelchair repair?
According to National Seating and Mobility, one of the country’s largest wheelchair manufacturers, it takes about six to twelve weeks to repair a wheelchair.
It can take between one and three weeks for repair shops to collect medical information and complete the necessary paperwork for a customer’s insurance or alternative financing source. It can also take one to three weeks for the estimate to be approved.
Wisconsin law requires the Department of Health to make a prior authorization decision within 10 days of receiving a repair request.
What was the purpose of Law 83?
With the passage of Act 83, you no longer need prior Medicaid authorization or a doctor’s prescription to repair your wheelchair or mobility device.
Senator Mary Felzkowski, a co-author of Bill 83, said eliminating pre-approval should speed up the repair process for wheelchair users.
“Most people in these wheelchairs have quality of life and mobility issues,” she told the Journal Sentinel in March. “They have jobs, and we’re taking all that away from them when we have to wait six weeks for an authorized repair.”
Who is covered by Law 83?
According to Health Department officials, Act 83 applies only to Medicaid members with fee-for-service health insurance, not those covered by managed care.
If you have a fee-based insurance plan, also known as a traditional insurance plan, suppliers are reimbursed for services provided.
The new rules do not apply to managed care plans such as Family Care, Family Care Partnership or the Program of All-Inclusive Care for the Elderly (PACE).
How quickly will Law 83 be implemented?
Health Department officials said the new regulations and the elimination of the Medicaid approval requirement for repairs would be implemented during the summer of 2024.
As of August 2024, the ForwardHealth website states that prior authorization is not required if:
- Wisconsin Medicaid and BadgerCare Plus purchased the equipment;
- The device is older than one year; and
- The fee is: $50.00 or less for home care durable medical equipment listed in the Durable Medical Equipment Index, $150.00 or less for manual wheelchairs or power-powered vehicles, and $300.00 or less for power wheelchairs.
What does Law 182 do?
Wisconsin Medicaid reimburses providers for the cost of repairing wheelchairs and other types of complex rehabilitation technology for members. Act 182 increases the amount of that reimbursement, which providers have long been accused of underpaying.
The law also sets a cap on the amount Medicaid can charge patients. With the passage of Act 182, Medicaid can only charge a maximum copayment of $3 for complex rehabilitation technologies, according to the Department of Health and Human Services. However, many members, such as children and pregnant women, are exempt from the Medicaid copayment.
Who is covered by Law 182?
Unlike Act 83, Act 182 applies to managed care programs such as Family Care, Family Care Partnership, or the Program of All-Inclusive Care for the Elderly (PACE).
How does the wheelchair repair process work in Wisconsin?
The process for repairing a wheelchair depends on how the repair is discovered. According to DHS, most repairs follow these steps.
- A person or their caregiver determines that repair is necessary.
- They contact their medical device provider, who evaluates the system in person or virtually.
- The repair company collects medical information and completes the appropriate documentation for submission to the insurance company.
- The DHS will decide on the prior authorization of the repair within 10 days of receipt.
- Spare parts are purchased and sent to the repair shop.
- The wheelchair user makes an appointment with the repair service to have the repair done. In some cases, customers leave their device at the dealer for repair or go to the repair shop to have their device repaired on site.
Are there scenarios in which a repair would be refused?
All repair orders are subject to a “medical necessity review.”
In Wisconsin, Medicaid does not reimburse for “excessive repairs,” according to the Department of Health Services. Rather than repeatedly repairing a severely damaged or ineffective device, it is often recommended that the person be issued a new device.
For example, if “the joystick on a member’s power wheelchair requires ongoing repairs, the wheelchair’s drive mechanism may need to be reconsidered in the interest of the member’s safety and the longevity of the device,” a DHS spokesperson said.
Likewise, Wisconsin Medicaid will not approve the purchase of a new item if only minor repairs are required to repair a device.
Providers are not permitted to deny care to a Medicaid member because of the member’s inability to pay the Medicaid copayment.
Can you rent or borrow a wheelchair or other mobility device if yours breaks?
If you are a member of the fee-for-service Medicaid program, the repair provider can likely provide you with a temporary device. Durable medical equipment providers are reimbursed for wheelchair rentals during maintenance.
Not all commercial insurance plans cover rental chairs, but some companies provide them for a small fee, according to a representative of National Seating and Mobility, one of the nation’s largest providers of complex mobility technology. Chair inventory can change weekly, so availability is not always guaranteed.
Managed care organizations also often cover the cost of a temporary mobility device or brace while a member awaits repairs.
Where can I find more updates on Wisconsin wheelchair repair policies?
- ForwardHealth communicates with providers about insurance policies, including rates, through ForwardHealth updates.
- Policy changes announced in ForwardHealth updates will then be included in the ForwardHealth online handbook on the ForwardHealth provider portal.
Tamia Fowlkes is a public investigator reporter for the Milwaukee Journal Sentinel. Reach her at [email protected].
This story was published with the support of Symposium “Journalism and Women” (JAWS) Health Journalism Fellowship, funded by The Commonwealth Fund. The organizations played no role in the reporting, editing, or presentation of this project.
