Question 1: Does my patient qualify for a custom wheelchair through the Ohio Medicaid program?

The Ohio Administrative Code Rule 5101:3-10-16 states that beneficiaries who are moderately to severely impaired may receive an adaptive seating system and wheelchair upon prior approval. This consists of multiple components (i.e. positioning devices) that are attached to the wheelchair or incorporated into a wheelchair seat and back. An adaptive seating system is an “individualized seating system” that is configured in such a way that the wheelchair cannot be used by any other individual.

Question 2: What is the criteria for classifying an impairment moderateor severe?

“Moderate Impairment” means the individual has a moderate impairment of strength and tone which results in an inability to maintain functional or
symmetrical postures; and/or flexible kyphosis; and/or dislocated hip with a leg length
discrepancy of less than two inches; and/or fixed contractures of the hips/knees that cannot be accommodated by standard components (i.e.
footrests, legrests)

“Severe Impairment” means the individual has severely abnormal (hyper or hypo) tone that prevents him or her from obtaining or maintaining symmetrical
postures, or abnormally fixed curvature of the spine.


Question 3: What other criteria must be documented on a Certificate of Medical Necessity?

If the consumer has severely abnormal tone that prevents him or her from obtaining or
maintaining symmetrical postures, or fixed curvature of the spine for which an individually customized seating system is necessary; or

Skeletal and/or physical deformities or abnormalities that require an individualized seating system;

Additionally, it should be noted if the consumer’s need for prolonged sitting tolerance, postural support to permit functional activities, or pressure reduction cannot be met
adequately by a planar type seat, a lap tray and/or a spinal orthotic. If a consumer also requires a spinal orthotic, document why both the seating system and the orthotic are
medically necessary for the consumer.