From the ITEM coalition on Power mobility devices. There's still time
to make your voice heard!
Kendall
An unreasonable man (but my wife says that's redundant!)
The reasonable man adapts himself to the world; the unreasonable one
persists in trying to adapt the world to himself. Therefore, all
progress depends on the unreasonable man.
-George Bernard Shaw 1856-1950
-----Original Message-----
From: Justice For All Moderator [mailto:[log in to unmask]]
Sent: Wednesday, September 27, 2006 7:58 AM
To: [log in to unmask]
Subject: A message from the ITEM Coalition
A message from the ITEM Coalition
(Independence Through Enhancement of Medicare/Medicaid)
In late August, Medicare issued a final local coverage
determination (LCD) for power mobility devices (PMDs). The new
coverage policy had serious access implications for beneficiaries
with mobility disabilities. The new LCD implements a series of
new payment codes for power wheelchairs and scooters, providing
Medicare coverage for those devices with functional capabilities
that place them into either Groups 1 (lowest functioning), 2, or
3 (highest functioning) PMDs.
Essentially, the new policy had three major problems. First, the
policy would significantly "downcode" the Medicare wheelchair
benefit placing many individuals into inadequate and often unsafe
power wheelchairs. Second, the new policy requires that a
beneficiary be unable to "stand and pivot" in order to qualify
for the highest functioning chair - a standard that fails to take
into account the functional needs of an individual. And third,
the policy implements a new definition of the "in the home"
restriction by denying access to wheelchairs that have
capabilities which are deemed unnecessary for indoor use.
Many ITEM Coalition members expressed serious concern with the
new policy, calling for a rescission of the entire policy, an end
to the downcoding, and the adoption of more functional-based
coverage standards. On September 20, 2006, CMS released
"clarifications" to the LCD that address some of the problems
identified by stakeholders while leaving several harmful
provisions in place.
The LCD clarifications will alleviate 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 would have been placed in inadequate and often
unsafe mobility devices. Additionally, the clarifications delay
the implementation date of the LCD from October 1, 2006 to
November 15, 2006. This delay allows clinicians and providers
additional time to become familiar with the coverage changes and
analyze the impact. CMS deserves credit fro these revisions.
The "stand and pivot" standard, however, remains a major problem.
The LCD states that in order to qualify for a Group 3 device, the
beneficiary must be "unable to independently stand and pivot to
transfer due to a neurological condition or myopathy." However,
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.
Finally, the clarifications do nothing to fix the new and more
restrictive interpretation of the "in the home" rule. The LCD
states that PMDs with capabilities not needed for use in the home
(identified as Group 4 devices) will be downcoded to a Group 3
device. 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.
The ITEM Coalition Steering Committee sent a letter to HHS
Secretary Leavitt as a response to the initial LCD (the letter is
posted at
www.itemcoalition.org/press/pr/LeavittletterPMDLCD.htm).
The Steering Committee will be following up with another letter
that thanks the Secretary for the recent changes and encourages
additional changes to ensure access to the appropriate mobility
devices for individuals with disabilities.
We urge you to contact Members of Congress asking them to support
legislation to eliminate Medicares "in the home" restriction for
mobility devices (S. 3677/H.R. 5983). Without enactment of "in
the home" legislation, Medicare will continue to utilize this
discriminatory coverage restriction to prevent access to
appropriate mobility devices for people with disabilities. You
can contact your Members of Congress via the Capitol switchboard
toll-free at 1-877-224-0041 or via email at
http://ga3.org/campaign/CommunityAccess.
The LCD and clarifications can be found at
http://www.trustsolutionsllc.com/DRAFT_LCD_Status.asp.
Please contact Emily Niederman at the ITEM Coalition with any
questions: (202) 349-4260. Thank you for your advocacy!
______________________________________________________________
For more healthcare news issues, see:
http://www.aapd.com/News/health/indexhealth.php
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