The Honorable Tom Allen
United States House of Representative
1127 Longworth House Office Building
Washington, D.C. 20515

November 9, 2007

Dear Representative Allen:

The National Council on Independent Living writes in support of H.R. 2231 “Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007”.

The National Council on Independent Living (NCIL) is the oldest cross disability, grassroots organization run by and for people with disabilities. Founded in 1982, NCIL represents over 700 organizations and individuals including: Centers for Independent Living (CILs), Statewide Independent Living Councils (SILCs), individuals with disabilities, and other organizations that advocate for the human and civil rights of people with disabilities throughout the United States.

NCIL is concerned that changes in Medicare coverage and reimbursement policies, such as Medicare’s competitive acquisition program, may inappropriately restrict consumer access to the quality health care that the Medicare program was created to deliver.  We are particularly concerned with how this new program may impact the availability of the highly customized, complex power wheelchairs, which people with disabilities desperately need to complete the daily activities that most of us take for granted. 

The “Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007” will exempt complex rehabilitation products and assistive technology products from Medicare’s competitive acquisition (or bidding) programs. We believe imposing a competitive bidding process on complex rehabilitative services will substantially undercut the quality of life for thousands of persons with disabilities.

Complex rehab technologies are not commodity products that are easily interchangeable.  Each consumer of complex rehab technology has individual and specialized needs that require extensive customization.

Competitive bidding fails to allow for the level of services and significant costs associated with the delivery of complex rehab technology to people with disabilities.
Properly fitted equipment has a significant role not only in providing consumers with their greatest level of independence, but also in preventing or delaying related medical complications or secondary conditions which can increase health care costs significantly.

Many people with disabilities may be forced to obtain wheelchairs from providers who do not have the experience or expertise that is needed to meet complex needs. For those in rural areas, a supplier experienced with the needs of people with disabilities may not be available and those that are available may not be able to provide the level of service that is desperately needed, such as follow-ups.

Significant savings will not be achieved by including complex rehab technology in competitive bidding.  CMS has acknowledged that the complex rehab product category is “small”.  Data released by CMS demonstrates that utilization of complex rehab products is low.  An industry commissioned study estimates the cost of the exemption over the first five years of the CB program to be $46 million.

While we applaud Congress and the Centers for Medicare and Medicaid Services for working to reduce cost and combat fraud and abuse, these efforts must not be accomplished at the expense of people with disabilities.

NCIL advances independent living and the rights of people with disabilities through consumer-driven advocacy.  NCIL envisions a world in which people with disabilities are valued equally and participate fully. For these reason, NCIL strongly support H.R. 2231, as it will preserve access to technologies people with disabilities must have in order to live independently in their homes and communities.

Sincerely,                                                       

Kelly Buckland                                    John A. Lancaster