ACTION ALERT: Stop Implementation of Harmful Medicare Wheelchair Policies!
On November 15, 2006, Medicare plans to implement several changes to its mobility device benefit that will severely restrict access to the more technologically-advanced power wheelchairs – the types of power wheelchairs often required by individuals with long-term disabilities and chronic conditions.
Background:
In August, Medicare issued a final local coverage determination (LCD) for power mobility devices (PMDs). The new LCD would implement a series of new payment codes for power wheelchairs and scooters, and create coverage standards for devices with functional capabilities that place them into either Groups 1(low functioning), Group 2, or Group 3 (high functioning) PMDs. Additionally, Medicare has recently issued new reimbursement levels for power wheelchairs that significantly cut payments to providers for Group 3 power wheelchairs. All of these changes are scheduled to take effect on November 15, 2006.
Problem #1: The new LCD states that in order to qualify for a high-functioning, Group 3 device, a beneficiary must be “unable to independently stand and pivot to transfer due to a neurological condition or myopathy.” This is a problem because there are many individuals with disabilities who may be able to stand and pivot but will need a Group 3 device to participate in their daily activities. This standard fails to take into account the functional needs of the individual and will result in significant access problems for individuals with Multiple Sclerosis, Parkinson’s Disease, Cerebral Palsy and many other disabilities.
Problem #2: The LCD would implement a new interpretation of the “in the home” restriction by denying access to wheelchairs that have capabilities which are deemed unnecessary for indoor use. Medicare currently covers wheelchairs that are needed by individuals for use in their homes but has not prevented individuals from using the devices outside of their homes. However, this new policy will not cover devices that have features that are useful for out-of-home use. This change will further confine Medicare beneficiaries with mobility impairments to the four walls of their homes.
Problem #3: The new reimbursement levels for high-functioning (Group 3) wheelchairs represent up to a 40% cut in prices paid to providers. While this will mean lower co-payments for beneficiaries, these reimbursement cuts will likely translate into serious access problems for beneficiaries as providers and manufacturers are unable to provide these high-end devices to Medicare beneficiaries at the new reimbursement levels.
Action Requested:
Call or email your members of Congress ask them to:
- Press Medicare to rescind the new power wheelchair coverage policy (LCD) and stop reimbursement cuts for Group 3 wheelchairs.
- Support legislation to eliminate Medicare’s “in the home” restriction on mobility devices (S. 3677/H.R. 5983). Without enactment of this important legislation, Medicare will continue to utilize this discriminatory coverage restriction which prevents access to appropriate mobility devices for people with disabilities.
To call your Senators or Representative: Call the Capitol Switchboard toll-free at 1-877-224-0041 and ask for the office of the Senator or Representative.
To email your Senators: Go to www.senate.gov, and select “Senators,” then your state, and then click on the web form links.
To email your Representative: Go to www.house.gov, select “Write your Representative” (the 4th link from the top in the left column), and follow the instructions provided.
A sample letter is below. Feel free to use all or part of it in composing your email.
NOTE: On October 18, Representatives Ramstad (R-3rd MN) and Langevin (D-2nd RI), Co-chairs of the Bipartisan Disability Caucus, sent a letter to the Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) expressing concern about the changes scheduled for November 15. If Rep. Ramstad or Rep. Langevin is your Representative, please thank him for his support on this issue.
For more information, please contact Alaine Perry, Director of Public Policy, at 301-495-4460.
Thank you for your advocacy!
Sample Letter to Member of Congress
Dear ______________,
I urge you to take immediate action to stop the devastating changes to the Medicare Power Mobility Device (PMD) benefit scheduled to take effect on November 15. The planned changes will severely restrict access to the power wheelchairs many people with disabilities need to live independent lives and participate fully in society.
In August, the Centers for Medicare and Medicaid Services (CMS) issued a final local coverage determination (LCD) for power mobility devices which places strict limits on access to “Group 3” power wheelchairs, the type of wheelchairs often needed by those with long term disabilities and chronic conditions.
CMS has also issued new reimbursement levels for these Group 3 wheelchairs which will cut reimbursements by up to 40 percent. These cuts will likely translate into serious access problems for beneficiaries as many providers say they will be unable to provide these high-end devices to Medicare beneficiaries at the new reimbursement levels.
Both of these changes are scheduled to take effect on November 15, 2006.
Access to appropriate mobility devices is essential to allowing persons with mobility impairments to live independently, to work, and to participate in community life. [Optional –if you use a power wheelchair, you may want to add a personal statement about the difference this has made in your life. Hearing your personal experience is important to policymakers.]
I strongly urge you to:
- Contact CMS and ask them to rescind the new LCD for power wheelchairs and to stop the planned cuts to reimbursement for Group 3 wheelchairs.
- Support the “Medicare Independent Living Act of 2006” (S.3677/H.R.5983), which would remove the “in the home” restriction on access to mobility devices. Without enactment of this important legislation, Medicare will continue to use this discriminatory coverage restriction which prevents access to appropriate mobility devices for people with disabilities.
Thank you very much for your support for mobility and independent living for persons with disabilities.
Sincerely,
(Your Name)