We are calling you to action!

Many of you may know that Medicare is implementing changes to its policy and reimbursement schedule that will go into effect November 15, 2006. These changes do not allow considerations for those with progressive diseases when prescribing equipment such as power wheelchairs and will decrease the reimbursement rates up to 40%. MDA, its National Task Force for Public Awareness, employees and Jerry Lewis are all contacting public officials in Congress to delay the effective date for these policies. We are encouraging the Center for Medicare and Medicaid Services (CMS) to rethink their current plan.

We are asking that you send correspondence to your congressional representatives about this issue. A sample letter is attached that you can use to write your representatives. For more information about the policies and Jerry Lewis' response, go to http://www.mdausa.org/news/061101lewis_medicare.html . You can find your state Congressional representatives by going to www.congress.org and typing in your zip code.

Thank you in advance for your assistance with this iniative. We hope that by postponing the effective date, CMS will reconfigure their plan to be best for the millions of Americans who have progressive diseases. At its current state, the plan will be detrimental to the independence and health of all those who use or plan to use power wheelchairs.
http://www.mdausa.org/news/061101lewis_medicare.html

I wrote my Congressmen this morning..thanks for the advocacy update...as I do believe PALS should be entitled to the wheelchairs they need...I too hope others will do the same ...Lisa

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.
______________________________

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

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
( taken from Bobby's ALSA post above)
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http://www.mdausa.org/news/061101lewis_medicare.html

Previous link to the MDA
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Weird...it seems the MDA and ALSA have a different stance on this issue.. It appeared that the MDA was urging contacting of congress as well when I clicked the link of the sample letter.. ...and the ALSA does not agree with the approach...or am I misreading something here ?
Jerry Lewis's post of his letter at the MDA was just two days ago...did circumstances change that quickly...or is there something more to it that I am missing?...
If anyone could share their thoughts it would be appreciated..my husband has his whelechair already..but I want to see PALS whom are newly diagnosed or slower progressing getting the wheelchairs they deserve as well...
Just Confused...Lisa

The MDA's most recent response ....on their website...as to the "current " state of the wheelchair situation....


PART OF NEW MEDICARE POLICY FIXED
TUCSON, Ariz., Nov. 3, 2006 — In a favorable move for people with progressive neuromuscular diseases, the Centers for Medicare and Medicaid Services announced a revision to Medicare’s coverage criteria for power wheelchairs.

The Power Mobility Devices policy change removes a reference to a person’s ability to stand and pivot transfer, with or without assistance, as criteria for eligibility for a power wheelchair with more than basic features.

The revised criteria now states “the patient’s mobility limitation is due to a neurological condition, myopathy or congenital skeletal deformity.”

However, no change was made to the new fee schedule that will reduce Medicare reimbursement by up to 40 percent for some wheelchairs.

“I’m gratified that the government listened to the pleas of our community and changed the eligibility policy, but I’m still very concerned about the cost issue,” MDA National Chairman Jerry Lewis said. “A quality wheelchair is often very expensive, but also very vital, to many people served by MDA. I won’t give up on our effort to get this part of the policy changed as well.”

The new schedule is slated to go into effect Nov. 15. Read more about MDA and Lewis’ efforts to stop the implementation of the policy and to learn how you can get involved.

http://www.mda.org/news/061101lewis_medicare.html

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It seems the MDA and ALSA do indeed..have different opinions on the issue...as well as how to respond...the MDA is still encouraging writing of our Congressmen as they feel the current changes to date are improving..but " still not satisfactory"....
On a personal note...the MDA clinics were very insturmental in getting my husband what he needed equipment wise and making adaptations to it...on 6 different occasions they appllied for Medicare coverage of different wheelchair adaptations...although in his present state he can no longer sit in a wheelchair more than an hour...for years they made it more comfortable for him and even went to three different operating modes as he progressed......I feel all PALS should be entitled to comfort and as much independence as posiible for as long as possible...the current changes in Medicare policies are "still" disturbing indeed...Lisa

when is it our turn ?