Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-543 - Medical equipment, supplies, and appliances
Section 182-543-4200 - Covered wheelchairs-Power-drive

(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:

(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.

(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 (6) of this section.

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

(6) Approval for more than one wheelchair. The agency pays for one manual wheelchair and one power-drive wheelchair for noninstitutionalized clients 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:

(7) Payment for more than one wheelchair. When the agency approves both a manual wheelchair and a power-drive wheelchair for a noninstitutionalized client, the agency pays to maintain both wheelchairs.