10/19/2006
Medicare Cuts Wheelchair Funding

Several suppliers say they won't be able to provide affordable power wheelchairs when cuts in Medicare reimbursements go into effect next month.

The government says it will no longer pay for powered wheelchairs for most Medicare recipients as of November 15th. Officials say that's because of fraud in the current system and that Medicare reimbursements for certain power wheelchairs were far higher than the prices paid by consumers and suppliers.

Most suppliers have supported overhauling the system, as many companies have abused it. But they say the government has gone too far.

Patricia Meier, a 63-year-old quadriplegic and Medicare recipient at Box Elder, says she needs to replace the powered wheelchair she's used for five years that prevents sores. Without Medicare it could cost her up to $20,000.
http://www.keloland.com/News/NewsDet...cfm?Id=0,51818

I hope they will continue to pay for power wheelchairs for PALS...as there use is certainly not fraud..it is a real need...Lisa

This seems right in line with the current admin's direction. First increase tax breaks for the wealthiest and then pay for them by cutting services to the neediest. Who did you say you are voting for next month?

John,
I agree this is awful....The healthcare system needs to be expanded not cut...I won't say whom I voting for online as that may be too controversial... except to say that I will be looking for a candidate who supports healthcare that "increases" gov't coverage of medical care....not one that cuts it..
Pals get way too little help as it is...Lisa

Does anyone know for sure if this is general cut for everyone or are they targeting fraudulent claims? I have a power chair need in my near future and will get it now if I need to. I do have a call into local ALSA to get their view. They make you jump through hoops sometimes.

eric guess you have seen this allready


Starting October 1, many people with Medicare who need a power
wheelchair will be in trouble. Under new rules set to go into effect,
people in need may only be able to get wheelchairs that are next to
useless, and potentially dangerous, outside their homes.

This is because the Centers for Medicare & Medicaid Services (CMS)
plans to implement new standards for what kind of power wheelchairs
to cover. It is a shift in policy that should be stopped.

The new policy adds a cruel twist to an already skewed coverage
policy for wheelchairs. CMS believes that Medicare should not cover a
power wheelchair for someone who needs one outside the home but can
get around inside their houses or apartments. This policy springs
from a misreading of the law: most people who need a power wheelchair
can make the case that they need it both at home and outside, so the
CMS policy has had limited impact.

Until now.

Unless they require special seating, people needing a power
wheelchair will only receive coverage for what many wheelchair users
call a "junk wheelchair," a device that has no ability to ride over
even the smallest bump and has extremely limited battery power.

Individuals who do need special seating may get coverage for a power
wheelchair that has some capabilities outside the home. But only
those with no capacity to "stand and pivot" from the wheelchair into
bed can get coverage for a power wheelchair with the battery power
and clearance capabilities many find essential to get around outside.
This category of devices would be denied to many people living with
multiple sclerosis, cerebral palsy, amyotrophic lateral sclerosis
(Lou Gehrig's disease) and other debilitating diseases.

These coverage criteria are clinically unsound. There is no basis for
using a "stand and pivot" test for determining coverage for a
wheelchair that has added clearance. Worse, relegating scores of
people with disabilities to "junk" wheelchairs and expressly denying
them devices that would allow them to leave their homes is dangerous—
many are bound to test the limits of these unsuitable wheelchairs.

CMS does have a legitimate interest in ensuring that Medicare only
covers power wheelchairs that are medically necessary and in stamping
out fraud. But this new policy is not the way to do it. The policy
should be put on hold until CMS can develop clinically sound
criteria. Please tell Health and Human Services Secretary Michael
Leavitt to stop the local coverage determination from taking effect
until the clinical aspects of this flawed policy are addressed.

For the longer term, Congress needs to prevent CMS from using its
outdated legal interpretation to deny people with Medicare access to
mobility devices that will give them the independence and quality of
life that is their right. Please write to ask your senator to
cosponsor S. 3677, bipartisan legislation that would eliminate
the "in-the-home" restriction.

Medical Record

"Developing political and legal standards are consistent with medical
opinion: the costs of isolation for people with disabilities can
include poorer health outcomes and higher systematic health costs.
Also, scientific evidence indicates that people who get inappropriate
mobility devices given their needs develop secondary medical
conditions. In light of technological advances that today make
appropriate equipment available and community integration possible,
CMS has a responsibility to update its interpretation of the Medicare
statute" ("Forcing Isolation: Medicare's `In the Home' Coverage
Standard for Wheelchairs," Medicare Rights Center, March 16, 2004).

"Medicare's new LCD [local coverage determination] will severely
restrict access to appropriate devices for many of the 6 million
beneficiaries with disabilities under the age of 65, as well as
beneficiaries with disabilities over 65 years of age. These new
coverage criteria are not based on functionality nor are they
intended to meet the functional needs of beneficiaries. Rather, they
are based on outdated standards that require individuals to be
completely nonambulatory to receive an appropriate mobility device
and will force many beneficiaries into inappropriate and low-
functioning mobility devices" ("Medicare Issues New Rules for Power
Mobility Device Benefit: From Bad to Worse," ITEM Coalition,
September 2006).

"`Wheelchairs make it possible for otherwise homebound individuals to
have the freedom and opportunity to get around outside their homes,'
[U.S. Senator Jeff] Bingaman said. `This bill allows people with
disabilities to live independently in their community and I hope my
colleagues in the Senate support it'" ("Bingaman Introduces
Bipartisan Legislation to Provide Medical Equipment Not Currently
Covered Under Medicare," press release from office of Senator
Bingaman, July 17, 2006).


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Humm, not looking too good. Thanks Bobby.

Significantly more stringent criteria for qualifying for power chairs is supposed to be effective November 15, 2006. The following is the information provided to me by the ALSA National Office when I asked about this subject.



Many in the ALS community may have heard about new coverage policies Medicare has proposed for power wheelchairs that are scheduled to be implemented on November 15, 2006 . The changes result from Medicare's attempt to cut down on fraud and abuse in the benefit for scooters and power wheelchairs, expenditures for which have risen from $43 million in 1995 to $1.2 billion in 2003 according to the Centers for Medicare and Medicaid Services (CMS).


We want you to know that the Patient Services and Advocacy Departments of The ALS Association are actively following the development of the proposed changes to ensure that people with ALS will continue to have access to needed power mobility devices. At this time, it is unclear to what degree the proposed changes will impact people with ALS specifically. The changes that have been proposed, including changes to the reimbursement rates paid to Medicare providers, apply to all power mobility devices ranging from scooters to high-end power wheelchairs and differ depending on the type of device and the needs of beneficiaries.


ALSA also is aware that action alerts and sample letters have been circulated that encourage people to contact CMS and Members of Congress to express opposition to the new reimbursement rates and coverage policies. Please keep in mind that these letters were not drafted by ALSA and are not written specifically for people with ALS, but for anyone who may need a scooter or any type of power wheelchair. Therefore, if you choose to send a letter, please remember that you may be asked to detail how the new rules will specifically impact you.


ALSA currently is requesting feedback from our Chapters as well as from individuals about their specific concerns with CMS' new reimbursement rates and coverage policies. The Patient Services Department is compiling this information and will work with the Advocacy Department to take any additional steps that are necessary to promote the interests of the ALS community.


We also are strongly encouraging Chapters and PALS to closely monitor this situation if the policies are implemented on November 15 without changes. Specifically, we are requesting people report to their local ALSA Chapter or to the Patient Services Department (alsinfo@alsa-national.org) any difficulties that PALS experience, such as issues with seating, transfer ability, and having the appropriate chair features. This feedback is absolutely essential and not only will help ensure that we accurately deliver the concerns of the ALS community to Congress and CMS, but also that Congress and CMS take immediate action to address these concerns.


ALSA will provide additional information as it becomes available. In the meantime, please contact the Advocacy Department (advocacy@alsa-national.org) or the Patient Services Department (alsinfo@alsa-national.org) if you have any questions or would like to share your concerns about the proposed changes.

Wheelchair funding to be cut
To combat fraud, Medicare reducing reimbursements
Ken Papaleo © News

Lauren Blakely, 24, listens during a news conference Tuesday at Craig Hospital, where officials described the impact of Medicare's plans to reduce reimbursements for power wheelchairs.STORY TOOLS
Email this story | Print By Rachel Brand, Rocky Mountain News
October 25, 2006
There is no question that Keith Copen needs his motorized wheelchair. The 59-year-old is paralyzed from the thighs down and the chair helps him shop, get to his van, and travel over snow and ice.
But for the tens of thousands of seniors who got Medicare to buy them motorized scooters in recent years, the benefit is less clear.

Now the government is cracking down on fraud and abuse in wheelchair industry, and Copen might pay the price.

"Without this kind of chair, I can't operate," he said Tuesday.

Many wheelchair suppliers, including several in Denver, will no longer provide power wheelchairs to Medicare recipients after Nov. 15, when dramatic cuts in Medicare reimbursement go into effect.

"(The chairs) are just going to be out of reach, unfortunately, for these people who need them so badly," said Marlene Tiffany, general manager of Adaptive Equipment Company, which is owned by Craig Hospital, an Englewood rehabilitation and research center for patients with spinal cord injury and traumatic brain injury.

Medicare is planning to cut reimbursement for power wheelchairs on average 22 percent, and as much as 40 percent in some cases.

The changes were a reaction to a 2004 study conducted by the Health and Human Services Inspector General. It found that Medicare paid far more for certain wheelchairs than consumers and suppliers, at times $6,000 for a wheelchair that cost $1,000.

Also, between 1995 and 2003, the amount Medicare paid for power wheelchairs increased from $43 million to $1.2 billion.

"We're cutting back only what we can call rampant fraud and abuse," said Mike Fierberg, a spokesman for the Centers for Medicare and Medicaid Services.

The government took nine months to craft its new reimbursement schedule, which defines 56 categories of wheelchairs.

The changes were aimed at making it more difficult for moderately disabled seniors - people with "the dizzies and wobblies" - to get government-paid wheelchairs.

The severely disabled won't be affected because "by and large, the more complex the chair, the smaller the impact of these (reimbursement) changes," Fierberg said.

Suppliers, advocates and manufacturers agree that the payment system needs to be overhauled. But they say the government has gone too far, and will hurt severely disabled patients who rely on custom, complex chairs.

Patients with cerebral palsy, spinal cord injuries and muscular dystrophy need special chairs. The arm rests, head rest, joy stick and foot rests are specially fitted to match a person's needs. The chairs' suspension systems cushion curbs.

Suppliers say they will no longer stock such high-end chairs, since they'll lose money selling them.

"For Keith, his only option is to go to a lesser chair," Tiffany said.

Longmont-based Sunrise Medical, the No. 2 manufacturer of power wheelchairs in the U.S., will trim research and development, and be forced to push manufacturing overseas, said Sunrise's Dr. Robert Hoover.

"We can certainly build chairs that can meet the new specifications," Hoover said. "But I don't think it's a chair you'd want to put your family member in."

JERRY LEWIS, MDA REQUEST POSTPONEMENT
OF NEW MEDICARE POLICY FOR POWER WHEELCHAIRS
TUCSON, Ariz., Nov. 1, 2006 — Jerry Lewis, national chairman of the Muscular Dystrophy Association (MDA), has asked U.S. Health and Human Services Secretary Michael Leavitt to postpone new Medicare pricing and coverage policies for power wheelchairs, citing the policies’ negative impact on people with muscular dystrophy and other severe disabilities.

The new fee schedule, slated to go into effect Nov. 15, reduces Medicare reimbursement rates for power mobility devices by up to 40 percent for some wheelchairs. In addition, new eligibility requirements make it harder for people with severe and progressive disabilities to qualify for more technologically complex power wheelchairs that promote health, safety and independence.

“Although CMS’ original intention was to combat fraud, CMS (Centers for Medicare and Medicaid Services) is itself misleading Americans by claiming that these new policies will provide appropriate power wheelchairs for all Medicare beneficiaries,” Lewis said in a letter to Leavitt, a copy of which went to President Bush and each member of Congress.

He added, “We’re extremely disappointed by this policy change because it’s detrimental to people with disabilities. The new eligibility criteria will make it very difficult for those with progressive diseases to receive power wheelchairs equipped for their needs.”

Lewis requested that implementation be delayed until the policy could be adjusted to better accommodate the needs of those with severe and progressive disabilities.

He told Leavitt that he’ll be willing to travel to Washington to meet with him, the CMS or any other group that could repair the problems with the proposed policies.

“These changes are so drastic and so detrimental to “my kids” and other Americans with progressive diseases that I’m prepared to drop everything and address this issue personally,” Lewis said.

Under the new policy, applicants who can transfer from bed to wheelchair by standing and pivoting, with or without assistance, won’t be eligible for power wheelchairs with more than basic features. This assessment doesn’t account for disease progression and fatigue, crucial factors when determining the wheelchair needs of a person with neuromuscular disease, Lewis said.

More complex features such as tilt, recline, stronger motors, custom headrests, and ability to navigate uneven terrain provide wheelchair users with more independence and safety. For instance, tilt-and-recline features assist users with self-transfers, are safer on steep inclines and help prevent pressure sores.

If chairs have fewer features needed for independence, the result may be to force people out of their homes and into long-term care facilities.

In addition, the new fee schedule places a greater financial burden on low-income people with severe disabilities and the nonprofit organizations that serve them.

Among its services for people registered with MDA, the Association provides financial help toward the purchase and repair of wheelchairs.

MDA is a voluntary health organization working to defeat more than 40 neuromuscular diseases through programs of worldwide research, comprehensive services, and far-reaching professional and public health education. The Association’s programs are funded almost entirely by individual private contributors.