Dear bobby,

As you may know, the Centers for Medicare and Medicaid Services (CMS) has proposed new coverage policies for power wheelchairs and scooters, which are scheduled to take effect on November 15, 2006. The Advocacy Department and the Patient Services Department of The ALS Association submitted comments to CMS when the agency first proposed changes to the Medicare wheelchair benefit and we have been actively following the development of the coverage policies to ensure that people with ALS will continue to have access to needed mobility devices.

We are pleased to let you know that Medicare has made several revisions to the proposed coverage rules. They include:

• Removed the “stand and pivot” transfer test as one of the coverage criteria for higher end power chairs, which frequently are needed by PALS. Under the original proposal, patients who could independently “stand and pivot” to transfer from their bed to their chair may not have been eligible for certain higher-end power chairs. With the stand and pivot language removed, the policy now provides coverage for these chairs if the “patient’s mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity.”

• Added language to ensure that disease progression is considered as a factor when determining eligibility for power chairs that have multiple power options. Under the new language, patients who may not yet need certain power features, such as power seating systems, but will need them in the near future, will be able to receive coverage for chairs with these features. The notice announcing this change specifically cited ALS as one of the conditions for which the language was added.

The revisions made by CMS help to remove some of the uncertainty about how the proposed policies would impact PALS. Because the original language was imprecise and subject to interpretation, it was unclear to what degree PALS would have been impacted by these coverage changes – changes that are broad and apply to all power mobility devices, not just those used by PALS. In fact, CMS originally proposed the changes to crack down on fraud and abuse in the power mobility benefit, particularly the benefit for scooters where much of the fraud has occurred, contributing to a dramatic increase in expenditures for the devices (from $43 million to $1.2 billion in just seven years).

Action Alerts/Petitions
We are aware that wheelchair and scooter suppliers as well as manufacturers have been circulating information on this issue, including action alerts and petitions that urge individuals to contact Congress and CMS. Please bear in mind that much of this information was written before CMS revised the proposed coverage policy. Moreover, this information was not written for people with ALS only, was not developed in consultation with The ALS Association and has not been endorsed by The ALS Association. Had these organizations approached ALSA, the only nationwide organization dedicated solely to the fight against ALS, before soliciting our Chapters and individual PALS, we would not have supported the advocacy approach they are employing.

Report Problems and Concerns
ALSA continues to follow this issue closely to ensure that the specific needs of people with ALS are met and that our concerns are addressed. Although we are pleased with the latest developments, it still is important for the ALS community to remain engaged in this process, as CMS also has changed the reimbursement amounts paid to suppliers of power mobility devices. Therefore, we encourage people with ALS and their families and caregivers to continue to share with us their concerns about this issue and report any difficulties PALS may experience accessing needed power mobility equipment.

In response to a request for feedback sent to our Chapters by ALSA’s Patient Services Department in October, we received helpful information from both PALS and Chapters. Again, please continue to send us your concerns and report to us any problems people experience accessing needed power mobility devices. You can report any concerns or problems to ALSA’s Advocacy Department (advocacy@alsa-national.org, 1-877-444-ALSA), or Patient Services Department (alsinfo@alsa-national.org, 1-800-782-4747).

A copy of the release announcing the revisions to the power mobility coverage policy can be found here. A copy of the revised coverage policy also is available on the site. If you have any questions about this update, please contact Pat Wildman in the Advocacy Department at pwildman@alsa-national.org or toll-free at 1-877-444-ALSA.
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The Amyotrophic Lateral Sclerosis Association, Capital Office
601 Pennsylvania Avenue, NW, Suite 900, South Bldg., Washington, DC 20004
(202) 638-6997 * Toll-free: 1-877-444-ALSA * Fax: (202) 638-6316
http://www.alsa.org/policy