Improving Mobility Policy

One of the principal goals of health care reform was to improve access to medical care and services, particularly for the most vulnerable in our society — the poor, frail, elderly and those living with disabilities. So it's unfortunate and ironic that some new policies, including provisions in the health care reform law, have instead made it more difficult for Medicare patients to receive the mobility assistance that can help them remain at home living safely and independently at a lower cost to our health care system.

Policymakers often overlook the value of power wheelchairs to patients with mobility impairments. Most take mobility for granted. But a power wheelchair can be the key factor that allows Medicare beneficiaries to remain in their homes.

Mobility providers have suffered a long string of obstacles and setbacks: the steep Medicare reimbursement cuts in recent years, implementation of the problematic bidding program, excessive and overreaching audits, confusing and inconsistent guidelines for documenting medical necessity and elimination of the first-month purchase option, among others. Mobility providers across the country say they now must determine whether it makes sense from a business perspective to continue providing power wheelchairs to Medicare patients.

We occasionally make progress. In April, the DME MACs allowed use of Advance Beneficiary Notices (ABNs) for Group 2 power operated vehicles and Group 4 power wheelchairs so that consumers can elect upgrades that best suit their needs. The previous policy had the unintended consequence of classifying these items as “non-covered” by Medicare, which meant that beneficiaries would have had to pay the full cost of these items since an ABN cannot be used for non-covered items.

The American Association for Homecare, National Coalition for Assistive and Rehab Technology, National Registry of Rehabilitation Technology Suppliers and other groups engaged CMS and the DME MAC medical directors seeking revisions to this policy so that Medicare beneficiaries would continue to have access to these products and related services. Still, there are numerous burdens.

Many providers now struggle when repairs are needed. In the past, Medicare fairly reimbursed providers for repairs, but the reimbursements have been slashed to the point that providers often lose money when fixing power wheelchairs for Medicare patients. As an unintended consequence of these policies, it's getting harder for providers to supply the equipment and services that Medicare beneficiaries need.