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.
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.
"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,
"`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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