United Spinal Action Alert
UPDATE: Victory on Medicare Wheelchair Policies – But More Changes Needed!
As a result of incredible advocacy on the part of many stakeholders, Medicare has made changes to the new local coverage determination (LCD) for power mobility devices (PMD) that will remove some of the worst access restrictions. Specifically, the recent changes eliminate a requirement that an individual be “unable to independently stand and pivot” in order to qualify for access to high functioning mobility devices. You should all be proud of winning this significant battle - but the war is far from over.
Problems that Remain:
- As you may know, Medicare recently issued new reimbursement levels for power wheelchairs that seriously cut payments to providers for many of the high functioning power wheelchairs. The reimbursement cuts are scheduled to take effect on November 15, 2006. The cuts are so severe that many providers say they will not be able to continue supplying these wheelchairs to Medicare beneficiaries. Therefore, these reimbursement cuts could create significant access problems for beneficiaries requiring high-functioning mobility devices.
- Although CMS has made positive changes to the recent LCD, the policy continues to be misguided in important ways. This is primarily due to the fact that Medicare’s long-standing and discriminatory “in the home” policy remains in place and is even more prominent in coverage standards than ever before! As long as this harmful restriction remain in place, Medicare will continue to deny individuals with mobility impairments the devices necessary to meet their functional needs – both inside and outside of their homes.
ACTION REQUESTED:
This issue has begun to attract significant attention in the press and with Congress. We need to keep the pressure on and let Congress know the importance of appropriate access to mobility devices.
Please call or email your Members of Congress and ask them to:
- Urge Medicare to stop the planned reimbursement cuts for the more technologically-advanced 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 may continue to utilize this discriminatory coverage restriction which prevents access to appropriate mobility devices for people with disabilities.
- Contact Health and Human Services (HHS) Secretary Leavitt and ask him to take action to eliminate the “in the home” restriction.
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 changes to the Medicare Power Mobility Device (PMD) benefit scheduled to take effect on November 15. The planned changes could severely restrict access to the power wheelchairs many people with disabilities need to live independent lives and participate fully in society.
CMS has issued new reimbursement levels which will cut reimbursements by up to 40 percent for the more technologically-advanced, “Group 3” power wheelchairs – the types of wheelchairs often required by persons with long-term disabilities and chronic conditions. These cuts will are likely to translate into serious access problems for beneficiaries, as many providers say they will be unable to provide these devices to Medicare beneficiaries at the new reimbursement levels.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 stop the planned cuts to reimbursement for the technologically-advanced “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.
- Contact Health and Human Services (HHS) Secretary Leavitt and tell him to take action to eliminate the “in the home” restriction in Medicare coverage policies.
Thank you very much for your support for mobility and independent living for persons with disabilities.
Sincerely,
(Your Name)
Additional Background Information:
In August, Medicare issued a final LCD for power mobility devices. The new LCD will 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 6 “groups.” (Only Group 1 (lowest functioning), Group 2, Group 3 (higher functioning) and Group 5 (pediatric) power wheelchairs will be covered by Medicare.)
The original policy had three major problems:
- First, the policy would have significantly “downcoded” the Medicare wheelchair benefit placing many individuals into inadequate and often unsafe power wheelchairs;
- Second, the new policy required that a beneficiary be unable to “stand and pivot” in order to qualify for the highest functioning chair (Group 3) - a standard that fails to take into account the functional needs of individuals, especially those who may be able to stand and pivot but need a Group 3 device to participate in their daily activities; and
- Third, the policy implemented a more restrictive definition of the “in the home” restriction by denying access to wheelchairs that have capabilities which are deemed unnecessary for indoor use.
Changes to Policy:
- On September 20, 2006, the Centers for Medicare and Medicaid Services (CMS) released “clarifications” to the LCD alleviating some of the access concerns associated with downcoding from Group 2 to Group 1 wheelchairs. This downcoding was of great concern because many individuals with disabilities could have been placed in inadequate and often unsafe mobility devices.
- On November 1, 2006, CMS made additional changes to the LCD that removed the requirement that an individual must be unable to “stand and pivot” in order to qualify for the higher functioning power wheelchair (Group 3). The revised criterion now states that in order to qualify for a Group 3 wheelchair “the patient’s mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity.” The final policy is posted at http://www.trustsolutionsllc.com/MedPolicies/PMD%20R2%20Final%20Draft.htm.