ITEM Coalition Members:

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released its final Medicare coverage decision for the iBOT Mobility System and, unfortunately, it appears to have changed very little from the restrictive proposed decision released in April.

Medicare states that it considers the “standard function” of the iBOT Mobility System to meet the definition of DME and finds the device, only in the standard function, to be reasonable and necessary for beneficiaries. The final decision is equivalent to a non-coverage decision as no beneficiary will realistically have access to this device.

The coverage decision is posted at CMS website. Also, we have attached a press release from the ITEM Steering Committee, below.

Thanks so much to those who submitted comments, attended meetings and put a great deal of time and energy into this effort.

-Emily
(202) 349-4260

ITEM Coalition Blasts Medicare’s Coverage Decision for iBOT Mobility System

Washington, D.C. - Today, the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition expressed profound disappointment with the Centers for Medicare and Medicaid Services’ (CMS’) National Coverage Determination for the iBOT® 4000 Mobility System, a highly functional mobility device for people with disabilities that climbs stairs and other obstacles.

On July 27, 2006, CMS released a final decision memorandum that would only provide coverage for the iBOT® 4000 as a standard power wheelchair and deny coverage for all of the iBOT’s innovative functions. CMS declined to create a new benefit category for the technology and cover the iBOT® 4000 as a single, integrated mobility device. Since Medicare only covers the “least costly alternative” device, no Medicare beneficiary will realistically have access to the iBOT.

“This amounts to a non-coverage decision for the iBOT Mobility System,” stated Peter W. Thomas, ITEM Coalition Steering Committee Member. “CMS had the opportunity to grant coverage for an innovative device for people with disabilities and instead slammed the door shut.”

This decision has broad implications for future coverage of all new technologies and assistive devices for people with disabilities. With this coverage decision, CMS has established unattainable standards of evidence for coverage of new assistive devices and unreasonable clinical efficacy requirements. This could create a ripple effect that discourages the development and coverage of other new technologies for people with disabilities.

The iBOT® 4000 is capable of combining multiple functions in one moveable unit allowing individuals with disabilities to climb stairs, improve reach, traverse various surfaces, and balance at standing-eye level. The device is not appropriate for all individuals with mobility impairments, but the ITEM Coalition believes it could greatly benefit a group of individuals with mobility needs that have not been met by any other device.

The iBOT’s stair-climbing technology is a possible solution to a current coverage gap in Medicare wheelchair policy, one that prevents some beneficiaries from receiving any wheeled mobility device if their homes have stairs.

“Medicare beneficiaries with stairs in their homes may be left without the mobility device they need to live independently,” explained Alaine Perry of the United Spinal Association and ITEM Steering Committee Member. “Here we have a possible solution to that problem for a small set of beneficiaries and Medicare is saying the device is not a covered benefit,” Alaine Perry continued.

“Why are prosthetic limbs and physical therapies covered by Medicare when a patient who has the potential to walk requires such technology to climb stairs in their home, but a device that allows the same function is not covered for people who are not capable of walking? It’s an inconsistent and discriminatory policy,” said Lee Page of the Paralyzed Veterans of America and ITEM Steering Committee.

ITEM Coalition Members were also surprised that Medicare did not take into consideration the fact that other government health programs such as a Veterans Administration and some Medicaid programs currently cover the iBOT Mobility System and have created specific coverage criteria for the device.

“It is hard to understand why Medicare is denying coverage of a device that other federal health programs, such as the Veteran’s Administration, have chosen to cover for their beneficiaries,” stated Lee Page. “We believe Medicare beneficiaries should have no less access to this important technology.”

Citing this coverage denial as part of a trend in Medicare’s treatment of assistive devices, the ITEM Coalition believes that CMS is not recognizing the value of assistive devices as they relate to access to home and community based care for people with disabilities. “The Bush Administration has a good track record in encouraging home and community-based care rather than institutional care, but you can’t live in your home and community if you can’t get access to mobility devices that will allow you to function in these settings,” said Thomas.

“This is about giving people the tools they need to reach their greatest functional potential,” stated Alaine Perry. “We will continue to encourage CMS and Congress to embrace advancements in assistive technology to help people with disabilities achieve independent living.”

The coverage decision is posted on the CMS website.

The ITEM Coalition was formed in 2003, and its 74 member organizations include a diverse set of disability groups, aging organizations, consumer groups, labor organizations, voluntary health associations, and non-profit provider associations. The ITEM Coalition’s purpose is to raise awareness and build support for policies that improve coverage of assistive devices, technologies and related services for people with disabilities of all ages. For more information on the ITEM Coalition, please visit www.itemcoalition.org.