NCIL Opposes Drastic Changes to Medicare
Coverage of Durable Medical Equipment (DME)
Changes will Prevent Access to Power Wheelchairs!

November 6, 2006

Call your members of Congress toll-free at: 1-877-224-0041 as well as Officials within Centers for Medicare and Medicaid Services.

Tell Them:

• Stop the Centers for Medicare and Medicaid Services (CMS) from implementing new policies for coverage of Power Mobility Devices (PMDs) that will drastically reduces the reimbursement and eligibility for new power mobility equipment; meaning people with disabilities who need certain types of motorized wheelchairs won't get them!

• Press Medicare to rescind the new power wheelchairs local coverage determination (LCD) policy and seriously examine the impact these reimbursement cuts will have on individuals requiring “Group 3” high functioning wheelchairs.

• Support the Medicare Independent Living Act of 2006 (S. 3677/H.R. 5983), which would eliminate Medicare’s "in the home" restriction on mobility devices. Without enactment of this important legislation, Medicare will continue to utilize this discriminatory coverage restriction which prevents access to appropriate mobility devices for people with disabilities.
  
• Contact Health and Human Services (HHS) Secretary Leavitt at 202-619-0257 and ask him to take action on the “in the home” restriction.  HHS has the authority to determine how Medicare interprets this language and we need to continue asking the HHS Secretary to change this policy.

***In addition to notifying your legislators, a number of key CMS officials must be contacted in opposition to these chances.  See below for contact information.

THE ISSUE:

The Centers for Medicare and Medicaid Services (CMS) has issued a new Power Mobility Devices (PMD) Coverage Policy that drastically reduces the reimbursement and eligibility for power mobility equipment that will take effect on November 15, 2006!  These reimbursement reductions, as high as 35% to 40%, combined with new restrictive coverage criteria, will limit and deny access to medically appropriate power mobility devices to Medicare beneficiaries, and will prevent access to high-functioning power wheelchairs for many people with disabilities!  Some suppliers say they will not be able to stay in business let alone provide the most appropriate equipment.

The new CMS coverage policy known as Local Coverage Determination (LCD) does not address progressive loss of function as a consideration in determining the most appropriate solution for someone using a power mobility device, therefore, these reductions will eliminate the availability of the appropriate power wheelchair and service required by most Medicare beneficiaries with complex mobility needs. 

CMS plans on implementing a series of new payment codes for power wheelchairs and scooters on November 15, 2006. These new codes will create coverage standards for devices with functional capabilities that place them into 6 “groups.”  The policy also implements 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.

As a result of continued discussions with advocates, politicians, manufacturers, suppliers, and clinicians, a decision has been made last week to further revise the Power Mobility Devices (PMD) policy.  One of the most significant changes is a revision to one of the coverage criteria for a “Group 3 power wheelchairs,” (which is the highest functioning power chairs), by removing the reference to “stand and pivot” transfer.  The revised criterion now states:  “The patient’s mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity.” Although the policy revisions and the effective date for the new codes remain unchanged – i.e., claims with dates of service on or after November 15, 2006, advocates still have time to urge Congress to assist people with disabilities in postponing CMS policies for Medicare’s damaging power mobility regulations.

The urgency of this matter is clear, as the November 15 implementation date approaches.  This will affect the durable medical equipment companies but the end result will mean people with disabilities who use certain types of motorized wheelchairs won't get them!

NCIL, as a member of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, is actively opposed to these changes.  For more information, visit the ITEM Coalition Website at: http://www.itemcoalition.org/press/pr/SummaryLCD_9-7-06.htm

The revisions of the Power Mobility Devices LCD and Policy Article can be found on the TrustSolutions Medical Policy/ LCD Status Page web site: http://www.trustsolutionsllc.com/DRAFT_LCD_Status.asp.

Additional information can also be obtained by going to www.complexrehab.com.

The following individuals need to be contacted conveying the concerns and need for a delay:

Secretary Michael Leavitt                                                                           
The US Department of Health and Human Services                                                  
200 Independence Ave. S.W.                                                                          
Washington, D.C. 20201                                                                   
Phone: 202-619-0257   

Fax: 202-690-7203                                                                             
mike.leavitt@hhs.gov                                                                                         

Leslie Norwalk
Acting Administrator
Centers for Medicare and Medicaid Services
The US Department of Health and Human Services
200 Independence Ave. S.W.,
Washington, D.C. 20201
Phone: 202-690-6726

Fax 202-690-6262
leslie.norwalk@cms.hhs.gov