Medicare Coverage for Grab Bars

1. Introduction

Given the data, it is not surprising that preventing falls is now a priority for many individuals and various organizations, including the federal government. Preventing falls, however, requires first understanding why people fall. Multiple factors increase the risk of falls including: being age 65 or older, a history of previous falls, impairments in gait or balance, home hazards, and use of psychoactive medications. The most prevalent suggestion for the prevention of falls in seniors is exercise; this recommendation is supported by a comprehensive analysis of fall interventions published by The Cochrane Collaboration in 2003. In a comparison of various interventions to prevent falling, exercise was the only intervention that reduced falls and fall-related injuries. Given, however, that many who are at risk of falling due to age or disability already have impairments in gait and balance, exercises intended to improve these things can be difficult to perform and may put the individual at a higher risk for a fall. So, the next step would be to reduce home hazards and the use of devices that would aid the prevention of a fall. For example, someone using a walker could exchange an old and worn walker for a new sturdy one with skid-resistant rubber tips that they can safely access through the use of a home modification such as a ramp. An example of such a device that applies to preventing falls in the bathroom would be grab bars. (Feng et al.2023)(Van et al.2021)(Wang et al.2020)(Dautzenberg et al.2021)(Zhang et al., 2021)(Sherrington et al.2020)(Papalia et al.2020)(Li et al.2021)(Zanotto et al.2023)(Clark & Arnold2021)

In recent years, falls and fall precautions have begun to emerge as important quality of care and patient safety issues for both the elderly and those with disabilities. According to data from the National Center for Injury Prevention and Control, unintentional falls result in approximately 234,000 non-fatal injuries among people aged 15 years or older in nine states. The most common cause of traumatic brain injury, fractures (dislocations), and sprains/strains were falls. In 2000, direct medical costs for fall injuries totaled more than $19 billion, with hospitals absorbing the largest share at 54%. Given the increase in the proportion of the population that is elderly or has disabilities, both the number of falls and the costs related to falls are likely to increase in the coming years.

1.1. Overview of Medicare

If coverage criteria are met, a safety device could be covered by the durable medical equipment (DME) provision. Grab bars are not covered by this provision as they are considered bathroom aids, and there is an explicit exclusion of coverage for DME not suitable for use in the home. This highlights a significant downfall of Medicare policy in that the program often fails to meet the needs of the elderly and disabled in helping to maintain a safe and functional residence. Tips on Home Safety Modification compiled by the Center for Disease Control (CDC), many of which are published by Medicare, are often not affordable to Medicare beneficiaries who need them the most.

Next, a Medicare Part A or Part B recipient must be receiving skilled nursing care at home or be homebound and under a plan of care established and reviewed regularly by a doctor. Finally, the cost of the safety device must be determined to be medically necessary; in other words, it must be a reasonable and necessary charge aimed at diagnosis or treatment. If all of these conditions are met, there is still no guarantee of Medicare coverage.

The first step to obtaining grab bars as a home safety device is to know if you are a Medicare beneficiary. Medicare coverage varies by plan and particular situations are evaluated case by case, but the following general coverage applies: Medicare Part A only covers home safety devices if they are deemed a medical necessity. Medicare defines a medical necessity as an item or service that is needed for treatment or to diagnose a medical condition and is prescribed by a doctor. The doctor that prescribes the device must also have an agreement with Medicare to accept assignment.

1.2. Importance of Grab Bars

Grab bars can be installed in various locations around the home to aid mobility. Primarily, they are used in bathrooms, where slippery surfaces can cause accidents. Stepping in and out of the bath can be difficult, often resulting in a trip or fall. Installing grab bars near the bath and beside the door can provide support and leverage. Often, people do not wish to admit they have a mobility problem, using towel racks and toilet paper holders as a substitute for a grab bar. These are not designed to support a person’s weight and can result in an injury. It is important to educate people on the potential injuries that can occur without using a proper grab bar. An injury gone unnoticed or ignored can lead to further complications and more healthcare costs. By using Medicare to cover grab bars, occupational therapists and home care workers can encourage clients to use this equipment, knowing that they have been properly installed and are a safe option for preventing injury. (Lam et al.2021)(Simning et al.2023)(Wiseman et al.2021)(Green et al., 2020)

Grab bars can be an important addition to the home when facing restrictions in mobility. With over 200,000 reported bathroom injuries per year in the USA, the majority involving the elderly, grab bars can reduce these injuries and significantly reduce healthcare costs. Studies show that they can sustain a weight of over 250 lbs and when correctly installed, will remain in place during a fall. Considering the majority of injuries are due to falls on the same level, grab bars can be a crucial tool in preventing these accidents. By using Medicare to cover grab bars, there is further potential for the elderly to take action in preventing injuries and reducing the strain on healthcare resources.

2. Medicare Coverage for Grab Bars

Should the accommodating accommodated the belief of medical necessity, the next footfall is to actuate eligibility. In some instances, the accommodating will accommodated the belief for acceptable Medicare advantage based on age or affliction status. In these cases, it is a almost simple assignment to verify accommodation. Unfortunately, there are abounding instances area an alone will not accommodated age or affliction requirements for Medicare accommodation due to top assets or assets of others in the home. In adjustment to actuate accommodation in these cases, the accommodating or provider accept to abide a appeal for a academic accommodation accommodation or advantage information. This footfall may generally be ambagious and arresting and in some cases, it is accessible that the accommodating or provider may be misinformed apropos accommodation by a adumbrative of the present or accomplished carrier. The cachet of accommodation can consistently be absolute by a Medicare advertisement appliance which will bright up any abashing apropos acceptance or eligibility. (Ankuda et al.2020)(Karpman et al., 2024)(Wikle et al.2022)(Karagiannidou & Wittenberg, 2022)(Staiger et al., 2024)

In adjustment to qualify, the accommodating accept to aboriginal accommodated the belief of medical necessity. This agency that it accept to be accounted actually all-important for the accommodating to acquire the grab bars in adjustment to accomplish it a safe ambiance in the home. An archetype of a bearings area this belief is met would be a accommodating who has afresh been absolved from the hospital afterwards a hip fracture. It would be of medical call for this accommodating to abstain a echo abrasion by deepening the home environment. In comparison, an alone who artlessly feels that it would be a acceptable abstraction to accept grab confined installed in adjustment to anticipate a approaching abrasion would not be advised to accommodated the belief of medical necessity. In this case, the grab confined would not be accounted to be a all-important cost and would not authorize for Medicare reimbursement.

Grab bars are frequently advertised as a capital durable medical equipment (DME) account in assisted living centers, acting as a safety aid for aged or disabled individuals. There is bound abstracts as to whether or not Medicare can in actuality be acclimated to awning the costs of grab confined for home use.

2.1. Eligibility Criteria

To be considered for coverage of a grab bar, a Medicare beneficiary must have a medical necessity and a grab bar must be considered to be a specific part of their treatment plan. The deductible and coinsurance apply for this Part B service. A beneficiary must be receiving (or recently finished) a skilled therapy episode for a specific medical condition. They must also meet the general eligibility guidelines for home health services. The grab bar must be considered to be a medical necessity and must be received from a Medicare enrolled durable medical equipment (DME) supplier. Grab bars are only covered under the DME benefit. If the supplier accepts assignment, the beneficiary will only have to pay 20% of the Medicare approved cost after the Part B deductible is met. If the supplier doesn’t accept assignment, the beneficiary may also be responsible for the difference between the approved amount and the supplier’s charge, in addition to the 20% coinsurance. Always check with your supplier to see how much you’ll need to pay. (Monahan & Schwarcz, 2021)(Rerucha et al., 2020)(Lam et al.2021)(Crowley et al.2020)(Simning et al.2023)(Naci et al.2022)

2.2. Coverage Limitations

An individual’s functional limitations and medical condition are not considered when determining whether or not it is medically necessary to have a grab bar. Therefore, a prescription and medical documentation stating that a grab bar is medically necessary to treat a specific medical condition is not sufficient to make it a covered item. Both the prescribed item and the individual’s condition must meet the coverage criteria. Grab bars are not in a lifetime category of DME or Part B services. Therefore, an initial determination that a grab bar is not covered or is the financial responsibility of the beneficiary, or a decision that continuing use of a grab bar is not meeting the coverage criteria, cannot be appealed to the QIC. An appeal of these determinations would have no legal effect. A grab bar can continue to be classified as not reasonable and necessary for an unlimited amount of time.

A grab bar equipped with a safety feature is not covered. Safety feature means the grab bar is designed or modified to protect against unsafe conditions existing in the bathroom. For example, a grab bar that is designed to fold up against the wall to prevent an individual from slipping on it is not covered because it is designed to protect against an unsafe condition, slipping on a grab bar. Installation of a grab bar does not increase the level of benefit or allow an individual to function any better than before, such that it would be considered a medical necessity. Therefore, the cost of the grab bar and its installation may not be considered as primarily medical in nature and would be the financial responsibility of the beneficiary.

2.3. Documentation Requirements

A prescription for a grab bar is required. This prescription should state that a grab bar is medically necessary and should be prescribed by the beneficiaries’ regular doctor. A note written on a ‘fee ticket’ or super bill is not sufficient documentation. Always bill in accordance with the ICD-9 code that best describes the reason for the grab bar. This will usually be an impairment in the beneficiaries’ balance or an abnormal gait. In order to expedite the processing of your claim, attach the prescription for the grab bar to the claim with a removable adhesive. This will reduce any potential denied claims due to lack of documentation and will prevent the necessity of refilling the prescription on a subsequent date. If the beneficiary is enrolled in a Medicare managed care plan, it is important to verify whether they are enrolled in a plan where services must be preauthorized. If grab bars preauthorization will improve the likelihood of getting a customer reimbursed, obtain an advance determination from the plan before billing Medicare. An advance determination is a decision by a CMS program, the BFCC, or a Medicare Advantage Organization (MAO) whether an item or service is covered and is necessary to confirm coverage for grab bars when required. If a claim for a grab bar is denied and an ABN was not obtained from the beneficiary, the beneficiary is not liable for payment. Always include a compliant HCPCS code on all claims for grab bars so processing will not be delayed. Any HCPCS code that begins with an ‘E’ is an over the counter (OTC) item and should not be used. Grab bars should be billed with the HCPCS code that most accurately represents the specific product being billed i.e. a wall attached bar versus a floor to ceiling pole. Any unclear or specific coding questions can be answered by contacting the DME carrier or DMERC medical review. Medicare Coverage for Grab Bars Grab bars are a type of durable medical equipment (DME) that are used to meet a medical need or for use in the home. Medicare beneficiaries who are eligible for Part B and/or enrolled in a Medicare Advantage plan may have coverage for grab bars if they meet coverage criteria. It is important to understand that coverage may vary based on the beneficiaries benefit plan. Always verify eligibility and coverage criteria with the specific managed care plan or original Medicare Part B.

3. Alternative Funding Options

Non-profit organizations may not be as reliable as getting funding from government programs, but it still is a viable option for financial assistance for home modifications. There are many non-profit organizations that have varying criteria for eligibility. For example, the Center for Independence may have a regional office providing the CIL Option program for the disabled and elderly to regain or keep independence in the home. Master’s Mission is a non-profit organization that may provide financial aid and volunteer-based construction assistance for home improvement projects for the disabled. A simple online search can help find the right non-profit program to fit your needs.

Another way to receive financial aid to install grab bars in your home is from the U.S. Department of Veterans Affairs. The VA provides an index of resources to help improve home mobility. The HISA (Home Improvement and Structural Alterations) program is a benefit for Veterans who are rendered to be 100% total and permanently disabled, or Veterans with service-connected conditions who are rendered to be less than 100% disabled. The HISA program offers financial and construction assistance to eligible Veterans to adapt home to meet certain conditions. It is a benefit up to $4,100 that may be provided to an eligible Veteran for both service-connected and non-service-connected disabilities. This funding can help many veterans from different ages and eras. Note that the Veteran must provide a prescription for the medical necessity of home alterations through a VA treatment plan. For more information regarding the HISA program or other services for home improvements for the disabled, see the VHA Prosthetic and Sensory Aids.

There are various government programs that can help the elderly or disabled, including Medicare recipients, to get financial assistance from alternative programs to provide durable medical equipment. Those that are not eligible for Medicaid, as a Medicare beneficiary, may still qualify for the Medicaid program to request the State to pay for Medicare cost-sharing (i.e., premiums, deductibles, co-payments, and/or Medicare services) and the purchase of Medicare covered services. Eligibility varies by state in terms of aged, blind, and disabled criteria and income limit. If you are a working disabled or the spouse of a working person with a disability, you may be eligible for the Working Disabled Program. It is a program that provides Medi-Cal to individuals with disabilities who are employed, but whose income and resources would make them ineligible for regular Medi-Cal. For complete information, contact your local Medicaid office.

3.1. Medicaid

Medicaid is a joint federal, state, and locally operated program that helps pay health care costs for individuals and families with low incomes and resources. Within certain limitations, Medicaid will fund the installation of DME. These limits are based around cost control, where the item or modification must cost less than a more expensive treatment or facility. Often times, it must be shown that the DME allows the beneficiary more independence in the community. Without the item or modification, the beneficiary may need to live in a facility. Because each state varies and may change its Medicaid policies and programs, it is always crucial to check with the state’s Medicaid office. Each state has a different Medicaid structure, and this article only offers a general structure for Medicaid and policies and programs in the State of Connecticut. In general, Medicaid is an important funding source for the elderly and those with disabilities who would like to remain in the community. Currently, for home modifications such as creating an additional entrance to a home for a ramp or widening doorways for wheelchair accessibility, there is a Home and Community Based Services (HCBS) waiver. These waivers allow individuals to remain in their homes or communities and prevent placement in an institution. Waiver services complement and/or supplement other services provided to the frail elderly and adults with disabilities. In the long run, it will help save Medicaid money because often times home modifications are less expensive than placement at an institution.

3.2. Veterans Affairs (VA) Benefits

There is no active legislation in place in the Veterans Health Administration for home safety modification services, such as the installation of grab bars. However, VA health care offers comprehensive services which include all medical care, inpatient and outpatient services, preventative, therapeutic, direct and ancillary. This may include home safety modifications and necessary durable medical equipment for disabled veterans if a clinical need is established, but it does not include the full range of home safety services that would normally be found in an insurance or health maintenance organization benefit package. This must be discussed with the physician and approved by a Veterans Care Team. Domiciliary Home and Primary Care Programs are also furnished for eligible veterans. Although there is no direct application or request procedure for these services, it begins with enrollment in the VHA healthcare program to establish eligibility. This is done by completing VA Form 10-10EZ or by simply visiting a local VA medical center or clinic. For more information about the prevention of slips, trips and falls in the home or community environment, that leads to injury and loss of independence.

3.3. Non-Profit Organizations

Now, private groups have noticed the cost-effectiveness and potential savings in healthcare costs with fall prevention. They have stepped in to voice their opinions in support of greater assistance for seniors in home safety.

It is clear that the cost of grab bar installation is much less than the medical cost that results from a fall. This fall could have been prevented if the individual had help in the installation, as in the case of Mr. M. Cost-effective measures like this should be carefully evaluated and considered by Medicaid.

My research argues that federal funding should give recipients of Medicaid the opportunity to receive assistance in the installation of home safety equipment. This is particularly important for those who have shown to be at high risk of falls and those who suffer from severe mobility limitations.

Whilst non-profit organizations might not give you immediate cash for your grab bars, they may allow you to save money in the long run. This is because they offer free installation services by volunteers and heavily discounted or even free bars. You will need to provide evidence of how the bars will prevent you from going into a care home for the organization to even consider you. However, for those worse off, it is money well saved. Examples of non-profit organizations offering such services are Elder Help and Rebuilding Together.

4. Conclusion

In conclusion, to obtain Medicare coverage for grab bars, the beneficiary must receive a written prescription from the physician or healthcare provider treating them for a specific medical condition. This condition must create a risk of falling in the home. The beneficiary must be enrolled in Medicare Part B, and the provider of the grab bars must be eligible to receive payment by Medicare. Under these conditions, the beneficiary may receive partial reimbursement for grab bars which have been installed in their home. Grab bars are not covered for beneficiaries of Medicare Part A. Together, this information acts as a guide for anyone looking to increase their safety and peace of mind by installing grab bars in their home. By obtaining documentation for a medical necessity, Medicare beneficiaries can receive financial help with this highly beneficial home modification.

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