Coalition Calls on Congress to Change Medicare Rule

Mobility equipment manufacturers and dealers are joining with power wheelchair users and doctors to call on Congress to prevent a major access problem for Medicare beneficiaries.

The Centers for Medicare and Medicaid Services (CMS) has issued a new Power Mobility Devices Coverage Policy and Fee Schedule that takes effect Wednesday. The coalition says the Medicare cuts will have a devastating impact on power wheelchair users in Indiana with significant disabilities and restrict many to their homes, beds or nursing homes.

People with disabilities have joined together with those who serve them to address a serious issue that could have a devastating impact on power wheelchair users in Indiana with significant disabilities, restricting many to their homes, to their beds or to nursing homes.

The Centers for Medicare and Medicaid Services (CMS) has issued a new Power Mobility Devices (PMD) Coverage Policy and Fee Schedule to be implemented in less than one week. The changes drastically reduce the reimbursement and eligibility for power mobility equipment. These reimbursement reductions, as high as 40%, combined with new restrictive coverage criteria, will limit and deny access to medically necessary power mobility to Medicare beneficiaries with disabilities, including Muscular Dystrophy, Multiple Sclerosis, spinal cord injury, ALS and brain injury.

Nancy Cotterill, president of People On Wheels states, “With a mandate to end fraudulent claims for scooters and power chairs, CMS has formulated a system where even those with the most debilitating forms of paralysis will not have access to the wheelchairs and attendant services they require. CMS now claims that these new policies will provide appropriate power equipment. This is patently untrue and even more damaging, insurers and other payers will follow suit and adopt the Medicare payment levels, effectively ending these benefits for the most deserving people.”

Power wheelchair users, their families and friends, clinicians, doctors, manufacturers and mobility equipment dealers are calling on Congress and President Bush to prevent major access problems for Medicare beneficiaries. Many in Indiana’s Congressional delegation are supportive of these issues and have been asked to call or write Health and Human Service Secretary Michael Leavitt, Acting CMS Administrator Leslie Norwalk, Acting CMS Deputy Administrator Herb Kuhn, and request they do the following:

1.) Postpone the November 15, 2006 PMD Fee Schedule and Local Coverage Determination for six months to allow adequate time to resolve all identified issues.

2.) Establish a new Fee Schedule using a reasonable methodology and accurate product classifications and pricing data.

3.) Make the necessary changes to the coverage policy to eliminate the risk of Medicare beneficiaries not receiving appropriate power mobility equipment.

4.) Once all identified issues are resolved, publish final pricing, coverage policy, and documentation requirements and allow for a 120 day training and implementation period prior to the effective date.

Background: For almost three years now CMS, physicians, clinicians, providers, manufacturers, and consumer groups have worked on improvements and safeguards to the Medicare power mobility benefit. However, the recent release by CMS of the final coverage policy and pricing is a major setback for people needing power mobility assistance has four major flaws:

1.) The new coverage policy unnecessarily restricts access to Medicare beneficiaries.

2.) The new fee schedule drastically reduces reimbursement for complex rehab products used by severely disabled consumers by up to 40%. These products are used by beneficiaries with severe diagnoses such as ALS, muscular dystrophy, cerebral palsy, spinal cord injury and severe brain injury. These reductions will eliminate the availability of the appropriate power wheelchair and service required by Medicare beneficiaries with complex disabilities.

3.) In developing the new fee schedule, CMS utilized a pricing methodology that has been universally recognized as flawed. In fact, CMS itself has admitted the methodology does not work and is in the process of putting a new methodology in place.

4.) These changes are the most dramatic since the establishment of the power mobility benefit under Medicare. It includes 64 new codes, new pricing, new coverage criteria, and new documentation requirements. How can these possibly be implemented effectively and smoothly with such a short period of time for physicians and patients to understand the changes?

5.) Press conferences such as this are taking place on November 13, 2006 in many cities across the country as people with disabilities join with those who serve them to fight this drastic measure. Report
Source: People on Wheels

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