Proposed/Adopted	WAC Subsection	Reason
Original WAC 182-543-4200
Proposed	WAC 182-543-4200 Covered wheelchairs—Power-drive. The medicaid agency pays for medically necessary power-drive wheelchairs when prior authorized. (1) Adults. (a) The medicaid agency pays for power-drive wheelchairs for clients age twenty-one and older when the prescribing physician certifies that the following clinical criteria are met: (((a)))(i) The client can ((independently)) effectively and safely operate a power-drive wheelchair;	• Moved subsection (1)(a) to subsection (1) so it is clear this provision applies to all subparts of subsection (1). • Retained the original term "independently" in what is now subsection (1)(a) because it is more clearly defined than "effectively."
Adopted	WAC 182-543-4200 Covered wheelchairs—Power-drive. The medicaid agency pays for medically necessary power-drive wheelchairs when priorauthorized. (1) Adults. The medicaid agency pays for power-drive wheelchairs for clients age twenty-one and older when the prescribing physician certifies that the following clinical criteria are met: (a) The client can independently and safely operate a power-drive wheelchair;
Original WAC 182-543-4200 (1)(b)
Proposed	(b) A power-drive wheelchair will((: (i))) provide the client the only means of independent mobility in any setting where normal life activities take place((; or (ii) Enable a child to achieve age-appropriate independence anddevelopmental milestones)). (c) The agency may also pay for power wheelchairs on a case-by-case basis when prior authorized as described in WAC 182-501-0165. The agency determines medical necessity based on documentation submitted by the provider.	• Added clarifying language regarding the applicable settings. • Replaced "The agency may also pay" with "The agency also pays" to clarify that payment is not discretionary. • Added medical necessity because that is the standard in determining authorization.
Adopted	(c) A power-drive wheelchair will((: (i))) provide the client the only means of independent mobility in any of the settings where the client's normal life activities take place(((ii) Enable a child to achieve age-appropriate independence and developmental milestones)). The agency also pays for power wheelchairs on a case-by-case basis that are determined medically necessary and when prior authorized as described in WAC 182-501-0165. The agency determines medical necessity based on documentation submitted by the provider.
Original WAC 182-543-4200(2)
Proposed	(2) Children. The agency reviews requests for power wheelchairs for a person age twenty and younger using the standard for coverage under the EPSDT program according to the provisions of WAC 182-534-0100.	Added the second sentence to this subsection to clarify medical necessity criteria.
Adopted	(2) Children. The agency reviews all requests for power wheelchairs for a person age twenty and younger using the standard for coverage under the EPSDT program according to the provisions of chapter 182-534 WAC. The agency determines medical necessity based on documentation submitted by the provider.
Original WAC 182-543-4200(3)
Proposed	(3) Three or four wheeled power-drive scooters/power-operated vehicles (POV). Additionally, for a three or four-wheeled power-drive scooter/power-operated vehicle (POV), the prescribing physician must certify the client's condition is unlikely to require a standard power-drive wheelchair within the next two years.	Added reference "for an adult." This clarifies that EPSDT directives apply and that coverage may be required for people under age twenty-one, regardless of whether the client's condition is unlikely to require a standards power-drive wheelchair in the next two years.
Adopted	(3) Three or four wheeled power-drive scooters/power-operated vehicles (POV). Additionally, for a three or four-wheeled power-drive scooter/power-operated vehicle (POV) for an adult, the prescribing physician must certify the client's condition is unlikely to require a standard power-drive wheelchair within the next two years.
Original WAC 812-543-4200(7)
Proposed	(7) Payment for more than one wheelchair. When the agency approves both a manual wheelchair and a power-drive wheelchair for a noninstitutionalized client who meets one of the circumstances in subsection (((5))) (6) of this section, the agency pays to maintain both wheelchairs.	Removed the reference to subsection (6), which subsequently became subsection (5). This allows other types of medical necessity situations to result in coverage of repairs to both wheelchairs.
Adopted	(7) Payment for more than one wheelchair. When the agency approves both a manual wheelchair and a power-drive wheelchair for a noninstitutionalized client ((who meets one of the circumstances in subsection (5) of this section)), the agency pays to maintain both wheelchairs.

(1) Refer to the table in WAC 182-501-0060 to see which Washington apple health programs include home health services, including medical equipment and related services, in their benefit package.

(2) For clients eligible under an alien emergency medical (AEM) program, see WAC 182-507-0115.

(3) Clients who are eligible for services under medicare and medicaid (medically needy program-qualified medicare beneficiaries) are eligible for medical equipment and related services.

(4) Clients who are enrolled in a medicaid agency-contracted managed care organization (MCO) must arrange for medical equipment and related services directly through the client's agency-contracted MCO. The agency does not pay for medical equipment or services provided to a client who is enrolled in an agency-contracted MCO, but chose not to use one of the MCO's participating providers.

(5) For clients who reside in a skilled nursing facility, see WAC 182-543-5700.

(6) Clients enrolled in the alternative benefits plan (defined in WAC 182-500-0010) are eligible for medical equipment when used as a habilitative service ((to treat a qualifying condition)) in accordance with WAC 182-545-400.

The medicaid agency pays for medically necessary power-drive wheelchairs when prior authorized.

(1) Adults. The medicaid agency pays for power-drive wheelchairs for clients age twenty-one and older when the prescribing physician certifies that the following clinical criteria are met:

(a) The client can independently and safely operate a power-drive wheelchair;

(b) The client's medical condition ((negates))prevents the ((client's ability to self-propel))client from self-propelling any of the wheelchairs listed in the manual wheelchair category ((in any setting where normal life activities take place)); and

(i)))provide the client the only means of independent mobility in any of the settings where the client's normal life activities take place((; or

(ii) Enable a child to achieve age-appropriate independence and developmental milestones)).

The agency also pays for power wheelchairs on a case-by-case basis that are determined medically necessary and when prior authorized as described in WAC 182-501-0165. The agency determines medical necessity based on documentation submitted by the provider.

(2) Children. The agency reviews all requests for power wheelchairs for a person age twenty and younger using the standard for coverage under the EPSDT program according to the provisions of chapter 182-534 WAC. The agency determines medical necessity based on documentation submitted by the provider.

(3) Three or four wheeled power-drive scooters/power-operated vehicles (POV). Additionally, for a three or four-wheeled power-drive scooter/power-operated vehicle (POV) for an adult, the prescribing physician must certify the client's condition is unlikely to require a standard power-drive wheelchair within the next two years.

(((3)))(4) Client's primary wheelchair. When the agency approves a power-drive wheelchair for a client who already has a manual wheelchair, the power-drive wheelchair becomes the client's primary chair, unless the client meets the criteria in subsection (((5)))(6) of this section.

(((4)))(5) Payment for primary wheelchair. The agency pays to maintain only the client's primary wheelchair, unless the conditions of subsection (((6)))(7) of this section apply.

(((5)))(6) Approval for more than one wheelchair. The agency pays for one manual wheelchair and one power-drive wheelchair for noninstitutionalized clients ((only when one of the following circumstances applies))when medically necessary for the client to have mobility in all settings where the client's normal life activities take place. Situations that demonstrate medical necessity include, but are not limited to, the following:

(a) The architecture of locations where the client's normal life activities take place are completely unsuitable for a power-drive wheelchair, due to conditions such as narrow hallways, narrow doorways, steps at the entryway, and insufficient turning radius;

(b) The architecture of the bathroom in locations where the client's normal life activities take place is such that power-drive wheelchair access is not possible, and the client needs a manual wheelchair to safely and successfully complete bathroom activities and maintain personal cleanliness; or

(c) The client has a power-drive wheelchair, but also requires a manual wheelchair because the power-drive wheelchair cannot be transported to meet the client's community, workplace, or educational activities. In this case, the manual wheelchair would allow the caregiver to transport the client in a standard automobile or van. The agency requires the client's situation to meet the following conditions:

(i) The client's activities that require the second wheelchair must be located farther than one-fourth of a mile from the client's home or along a pathway that does not provide for safe use of a power wheelchair; and

(ii) Cabulance, public buses, or personal transit are not available, practical, or possible for financial or other reasons.

(((6)))(7) Payment for more than one wheelchair. When the agency approves both a manual wheelchair and a power-drive wheelchair for a noninstitutionalized client ((who meets one of the circumstances in subsection (5) of this section)), the agency pays to maintain both wheelchairs.