INTEROFFICE MEMORANDUM

							                                    STATE OF FLORIDA




                          AGENCY FOR HEALTH CARE ADMINISTRATION
JEB BUSH, GOVERNOR                                                    RUBEN J. KING-SHAW, JR., SECRETARY




                                                     Policy Transmittal 99-07
                                                     Re: Customized/Motorized Wheelchairs



This letter clarifies the agency’s policy regarding customized/motorized wheelchairs for
Medicaid eligible adults (over 21 years of age).

The agency received a final order in the case of Esteban v. Cook. The order, in part, stipulated:

“Plaintiff’s Motion for Class Certification is GRANTED. The certified class is defined as all
Florida Medicaid eligible individuals who have been diagnosed with severe mobility
impairments and are over age 21 and who need or will need motorized and customized devices
and services as prescribed by their treating professionals.”

For the remainder of the 1998-2000 Medicaid HMO contract year, the customized/motorized
wheelchairs for HMO enrolled adults will be the responsibility of Medicaid fee-for-service.
However, according to Attachment I, B.8.f., the plan is responsible for:

“Determining the need for non-covered services and referring the member for assessment and
referral to the appropriate service setting (to include referral to the Women, Infants and Children
program (WIC) and Healthy Start) utilizing assistance as needed by the Area Medicaid Program
office. (The plan must also refer EPSDT eligibles to the Area Medicaid Program office to obtain
assistance in scheduling dental services and transportation services, if these services are not
covered by the plan.)”

This change in Medicaid policy was effective October 1, 1999, and will be reflected as a revision
to the Durable Medical Equipment (DME) Coverage & Limitations Handbook. In addition,
Medicaid DME providers will be sent correspondence directing them to their local Medicaid
office for assistance with applicable prior authorization requirements and claims adjudication for
services provided to HMO enrolled adults through June 2000.

In Medicaid fee-for-service, motorized wheelchairs do not require prior authorization and are


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reimbursed on a monthly rental basis, for a maximum of 10 months. Because Medicaid fee-for-
service will cease payment for HMO enrollees’ motorized wheelchairs after June 30, 2000, DME
providers are being encouraged to inform the plan of their intent to provide a motorized
wheelchair for an enrollee.

Should you have any questions regarding this issue, please contact your plan analyst at
(850) 487-0640.

                                                 Sincerely,



                                                 Pamela Anne Thomas, Acting Chief
                                                 Bureau of Managed Health Care

cc:    Pete Buigas
       Gary Crayton
       Bob Sharpe
       Maureen Hemmerly
       Unit Managers
       Program Administrators
       Plan Analysts
       Areas 1 –11 Medicaid HMO Liaisons