ITEM Coalition Members and Friends:

On November 15, 2006, Medicare plans to implement several changes to its mobility device benefit that will prevent access to high-functioning power wheelchairs – the types of power wheelchairs often required by individuals with long-term disabilities and chronic conditions.

TELL YOUR MEMBERS OF CONGRESS:
These Policy Changes Must be Rescinded
to Protect Access to Important Mobility Devices for People with Disabilities!

Background:

Related Items [PDF File] Letter to CMS on Power Mobility Devices Revisions to Medicare LCD for Power Mobility Devices

In August, Medicare issued a final local coverage determination (LCD) for power mobility devices (PMDs). The new LCD would implement a series of new payment codes for power wheelchairs and scooters, and create coverage standards for devices with functional capabilities that place them into either Groups 1(low functioning), Group 2, or Group 3 (high functioning) PMDs. Additionally, Medicare has recently issued new reimbursement levels for power wheelchairs that significantly cut payments to providers for Group 3 power wheelchairs. All of these changes are scheduled to take effect on November 15, 2006.

Problem #1: The new LCD states that in order to qualify for a high-functioning, Group 3 device, a beneficiary must be “unable to independently stand and pivot to transfer due to a neurological condition or myopathy.” This is a problem because there are many individuals with disabilities who may be able to stand and pivot but will need a Group 3 device to participate in their daily activities. This standard fails to take into account the functional needs of the individual and will result in significant access problems for individuals with Multiple Sclerosis, Parkinson’s Disease, Cerebral Palsy and many other disabilities.

Problem #2: The LCD would implement a new interpretation of the "in the home" restriction by denying access to wheelchairs that have capabilities which are deemed unnecessary for indoor use. Medicare currently covers wheelchairs that are needed by individuals for use in their homes but has not prevented individuals from using the devices outside of their homes. However, this new policy will not cover devices that have features that are useful for out-of-home use. This change will further confine Medicare beneficiaries with mobility impairments to the four walls of their homes.

Problem #3: The new reimbursement levels for high-functioning (Group 3) wheelchairs represent up to a 40% cut in prices paid to providers. While this will mean lower co-payments for beneficiaries, these reimbursement cuts will likely translate into serious access problems for beneficiaries as providers are unable to provide these high-end devices to Medicare beneficiaries at the new reimbursement levels.

Action Requested:

Call your members of Congress toll-free at 1-877-224-0041 and ask them to:

• Press Medicare to rescind the new power wheelchairs coverage policy (LCD) and seriously examine the impact of these reimbursement cuts on individuals requiring high-functioning, Group 3 wheelchairs.
  
  
• Support legislation to eliminate Medicare’s “in the home” restriction on mobility devices (S. 3677/H.R. 5983). 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.

**For your reference, attached is a recent letter from the ITEM Coalition Steering Committee to HHS Secretary Leavitt regarding the LCD and reimbursement changes for power mobility devices. Also attached is a letter from Congressmen Ramstad (R-MN) and Langevin (D-RI), co-chairs of the Bipartisan Disabilities Caucus, to the CMS Administrator regarding these recent mobility device changes.

Please contact Emily Niederman at the ITEM Coalition (202) 349-4260 with any questions.

Thank you for your advocacy!