Breaking news from the ITEM Coalition on power mobility devices.
Kendall
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
Date: Fri, 10 Nov 2006 13:46:16 -0500
From: Justice For All Moderator <[log in to unmask]>
To: [log in to unmask]
Subject: Action Alert: Important Changes to Wheelchair Coverage Policy
Action Alert: Important Changes to Wheelchair Coverage Policy
- Access Concerns Remain
Dear ITEM Coalition Members and Friends:
As a result of incredible advocacy on the part of many
stakeholders, Medicare has again made changes to the new local
coverage determination (LCD) for power mobility devices (PMD) that
will alleviate additional consumer access concerns. 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.
Background:
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
www.trustsolutionsllc.com/MedPolicies/PMD%20R2%20Final%20Draft.htm
Problems that Remain:
* 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 the 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.
* Medicare has 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 and many
providers indicate they will not be able to continue supplying
such devices to Medicare beneficiaries. Therefore, these
reimbursement cuts will create significant access problems for
beneficiaries requiring high functioning mobility devices.
ACTION REQUESTED:
Although the recent changes to the LCD are important improvements,
we must continue to advocate for a reasonable Medicare wheelchair
policy. This policy must reflect the true functional needs of
individuals with mobility impairments and recognize the important
role of wheelchairs and other assistive devices in the goal of
independent living for people with disabilities.
Please call your Members of Congress toll-free at 1-877-224-0041
and ask them to:
1. 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.
2. Contact Health and Human Services (HHS) Secretary Leavitt and
ask him to take action on the "in the home" restriction. The
agency has the authority to determine how Medicare interprets
this language and we need to continue asking the HHS Secretary
to change this policy.
3. Press Medicare to seriously examine the impact of the new
reimbursement cuts on individuals requiring high-functioning
wheelchairs.
*Please contact Emily Niederman at the ITEM Coalition at
(202) 349-4260 with any questions.
*
Thank you for your advocacy!
______________________________________________________________
-----------------------
To change your mail settings or leave the C-PALSY list, go here:
http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=c-palsy
|
