In developing new criteria for reimbursement of both power mobility and other mobility equipment, theCenters for Medicare & Medicaid Services(CMS; Baltimore) clearly has accepted the argument that mobility equipment can help reduce medical costs not only for the “bed- and chair-confined” but also for those who have some movement outside these traditional categories, but still are very limited.

The understanding comes with a comparatively new acronym.

Impaired mobility and difficulty in performing what CMS terms MRADLs, or mobility-related activities of daily living – from “toileting” to “grooming” – come with “a multitude of physiological and psychological consequences” affecting both health and quality of life.”

The need for assistance also is likely to be related to both psychology and environment issues, not just to the person’s disability, CMS said. Two people with the same disease diagnosis, it said, “may experience vastly disparate functional limitations,” given differences in “muscular spasticity, cognitive deficits, the availability of a caregiver and the physical layout, surfaces and obstacles in [their environments].”

It adds: “Many beneficiaries experience co-morbid conditions that can impact their ability to safely utilize [mobile assistive equipment] independently or to successfully regain independent function even with mobility assistance.”

Restriction on mobility, the agency says, can result in “venous thrombosis, osteoporosis, under-nutrition, protein-energy malnutrition and poor hygiene.” Com-pared to those who can meet their MRADL needs, those with MRADL “assistance deficits” are more likely to be in poorer health, CMS said.

The result of these conclusions: “CMS believes the environment must be assessed for each individual as specified in the conditions for coverage,” with such assessments to be made by local contractors.

– Don Long, Managing Editor