Change in Medicare Wheelchair Policy May Prevent Texas Beneficiaries from Receiving Mobility Assistance Starting January - Advocates, Providers Ask Congress to Delay Implementation of New, Mandatory Rental Policy.
Since 1988, San Antonio resident Martha Oliver, 69, has used a power wheelchair that has allowed her to remain independent in her home.
She lives alone, but with help from the power wheelchair provided through Medicare and occasional visits from her daughter, she can groom, eat, and get to the bathroom. Because she can perform these daily necessities of life, Oliver can stay in the home she loves, rather than being placed in a nursing home or another care facility.
But now, like many other Medicare beneficiaries and home medical equipment providers, she is worried about whether new policies and regulations will allow Medicare patients to continue receiving power wheelchairs in the future.
"This power wheelchair is very important to me because I don't have the strength to push a manual wheelchair," said Oliver, who had polio and open heart surgery. "With the power wheelchair, I can do many things in my home for myself, and my daughter helps me with cooking. The power wheelchair allows me to have independence."
But Oliver is scheduled to receive a replacement power wheelchair next year, and even though she certainly should continue to qualify for it, she still worries about whether changes in Medicare policy will make obtaining a new power wheelchair more difficult. "I'm supposed to receive a replacement chair in 2011," she said, "but with all the changes I don't know if I'll get it."
Access to power mobility assistance for Medicare beneficiaries may be jeopardized by a new law that ends the first-month purchase option for patients.
With the elimination of this option, the government plans to reimburse providers through rental payments over the first 13 months that a patient has a power wheelchair. But in the sluggish economy, most providers are unable to obtain the financing they need to transition to this change. The change is scheduled to be implemented in two weeks, on January 1, but providers, consumer groups, and Medicare patients have all asked Congress to delay implementation for one year so that providers can have time to adjust their business models to account for the significant cash flow problems created by the new policy. Many providers say they will no longer offer power wheelchairs or even close their businesses because of this policy change.
The minimal cost to delay this provision would be fully paid for by a one percent reduction in reimbursement rates for standard power wheelchairs, and would not add a penny to the deficit.
Providers estimate that the new rental policy scheduled to begin January 1 will slash their cash-on-hand by 40 percent in the first year. In addition, the transition to providing rented power wheelchairs carries financial risks that some providers may be unwilling to take. For instance, if a patient is placed in a nursing home or dies during the rental period, the providers must pick up the power wheelchair and custom accessories from the patient, and the government rental payments will end for that patient.
There are also repercussions for Medicare patients. Providers would have an inventory of used wheelchairs that might be re-rented to other Medicare beneficiaries, giving them used equipment that might not fit their specific needs as well as a new power wheelchair customized for them.
Clearly, many lawmakers recognize the scope of the problems that will be created if the policy is not delayed. Members of the U.S. House of Representatives and the U.S. Senate have signed letters asking the chairs and ranking members of key congressional committees to support the delay. In their letter, which was signed by 44 of their House colleagues, Reps. Jim Langevin (D-RI) and Glenn Thompson (R-Pa.) noted that "providers unable to secure financing and prepare for this substantial change in reimbursement policy will be unable to continue to provide power wheelchairs, resulting in a loss of jobs, economic revenue, and beneficiary access to a physician-prescribed power wheelchair."
Furthermore, the bipartisan letter underscored the benefit to patients receiving power wheelchairs and the savings in Medicare spending.
"Furnishing power wheelchairs to Medicare beneficiaries saves the program millions of dollars a year by allowing vulnerable beneficiaries to remain safe and independent in their homes and communities," the letter said. "Without access to power wheelchairs, thousands of beneficiaries would face additional hospitalizations, home health visits and other clinical services due to falls and other injuries that occur because of compromised mobility. In addition, power wheelchairs often postpone or alleviate the need to place an individual in a long term care facility."
Providers also noted that the reimbursement changes would be coming at a time when their businesses are already burdened with a number of other policy and regulatory issues. Many providers are confronting excessive government audits and delays in reimbursement payments. Furthermore, the Medicare program is expanding the flawed, so-called competitive bidding program, and wheelchair providers have seen their reimbursement rates in Medicare cut by more than 35 percent over the last five years.
"There have been a number of significant changes in recent years to Medicare policies, and many businesses can't endure any more financial risk and continue to offer quality products and services to Medicare beneficiaries," said Annie Nation, owner of Scooters Unlimited in Plano, Texas. "Clearly, there is a serious disconnect with the Washington policy makers. They don't realize that the transition to a rental policy for power wheelchairs is a dramatic change for providers and that we need more time to make this work. Hopefully, Congress will act in the next few days and grant a delay in implementing the change."
Obtaining a delay in the policy is also a priority for many consumer advocacy groups. Congress has received letters from groups such as the United Spinal Association, American Association of People with Disabilities, National Council on Independent Living, National Spinal Cord Injury Association, Paralyzed Veterans of America and the Association for Programs for Rural Independent Living.
"We are very concerned about the effect this new policy would have on Americans with disabilities who depend on Medicare for their mobility assistance," said Kelly Buckland, executive director of the National Council on Independent Living. "The rental policy will be most devastating to people in rural areas who will have delays in receiving power wheelchairs or won't get them at all. We urge Congress to delay implementation of this policy, so that providers can make the necessary arrangements."
The American Association for Home-care represents durable medical equipment providers, manufacturers, and other organizations in the home-care community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 home-care locations in all 50 states. Visit www.aahomecare.org
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