Children who use a wheelchair for daily mobility should also have an opportunity to change positions throughout the day. Standing in a standing frame is a way to decrease the risk of complications that can result from prolonged use of a wheelchair or from immobilization. Since the late 1950’s, physicians and therapists have recommended standing programs for the variety of medical and health benefits that occur when maintaining an upright standing posture. However, in addition to the physiological benefits (decreased risk of leg or foot contractures, increased or maintained range of motion, decreased leg spasticity, improvement in bowel and bladder function, aides respiratory function, decreased risk of skin ulcers, maintained or regained bone density, etc…) many children also experience significant psychological benefits from being in the upright standing position, such as improved self-esteem, increased cognitive and social development.
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Children are usually assessed for a standing program by their private or early intervention physical or occupational therapist. This may take place as early as 10-12 months of age; about the same time that their normally developing peers would be starting to stand. Assessment can also be at an older age in cases of degenerative or progressive neuromuscular disease, or from an acquired injury or trauma. If the physician agrees and there are no contraindications to weight bearing found for the child, the clinician will discuss with the family the specific benefits for a home standing program. When all are in agreement on the need for a standing frame, they will proceed towards acquisition.
For the greatest success in getting a standing frame paid for by the child’s funding source, its best to utilize the “Team Process”. The team usually consists of the consumer/child, their caregivers/family, current clinician(s) (PT/OT), and the DME/CRT (durable medical equipment/complex rehab technology) supplier. The team should first meet to discuss all of the standing frame technology available that meet the child’s needs. A trial of different types of standing frame may happen at this time.
When the best standing technology to meet the child’s need is determined, the clinician(s) involved will write a (LMN) letter of medical necessity for the standing frame and get it to the child’s physician for approval and co-signature. When the letter of medical necessity is signed by the physician it is sent to the DME/CRT supplier for submission to the payer source to determine coverage and payment.
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Once coverage and payment are approved, the DME/CRT supplier will order the standing frame from the manufacturer. When the standing frame arrives the supplier will schedule delivery, set up and product education with the child/family and the prescribing clinician(s). This is the time that fine tuning of the device and the home standing program will happen.
If payment is not approved, the family is faced with a denied claim. Appealing the decision is the best way to gain access to this important prescribed technology. The process for an appeal usually follows this pathway:
- Start by reviewing the documentation that was submitted. Was it complete?
- Know the insurance appeals process for your payer source by calling your payer source or checking in your policy manual.
- Request an appeal in writing. This written request must be received by the payer within a specified time frame.
- Identify potential expert witnesses such as a Physical Therapist, Occupational Therapist, Physiatrist, etc.
- Contact your local PAAT (Protection Advocacy for Assistive Technology) to assist with the appeal.
Here are the four basic categories of standing frame systems that exist and maybe consider during an assessment;
- Standing frame one position: i.e.; either a prone stander, supine stander, or upright stander.
- Standing frame multi-position: i.e.; one stander that can function in three ways, prone, supine and upright by moving parts.
- Sit to stand standing frame: i.e.: a standing frame that transitions from sit to stand with the ability to stop at any position in between.
- Standing frame mobile or dynamic: i.e.; can be any of the above that allow the user independence to manually move the standing frame.
For children who use wheelchairs, and are at risk for medical issues associated with immobilization, a standing frame is an excellent technology to increase their physiological and psychological benefits.
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Nancy Perlich, COTA, ATP is the reimbursement specialist at Altimate Medical, Inc. She has worked in the complex rehab industry for more than 25 year as a clinician, supplier and currently a manufacturer. Nancy is a FON with NRRTS and a member of the NCART Standing Device work group.
Helpful Articles
- Mobility for Children with Special Needs [4]
- Why Using a Wheelchair Is the Opposite of Giving Up [5]
- Dreams Made True: New Wonders for Walking [6]
- The Parents’ Guide to Wheelchair Van Shopping [7]
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This post originally appeared on our May/June 2012 Magazine [17]