Legislators Join Industry Protest of PMD Cuts

WASHINGTON–Legislators around the country are joining the HME
industry’s fight against power mobility reimbursement cuts.

Last week, six representatives from Ohio urged HHS to postpone
CMS’ new power mobility reimbursements, set to take effect Nov. 15
(see HomeCare Monday, Oct. 9). The fee
schedule calls for cuts of more than 40 percent for some equipment,
a move the legislators say will restrict patient access.

“Trying to save dollars at the expense of someone’s quality of
life is not good policy,” Reps. Tim Ryan, Ted Strickland, Dennis
Kucinich, Sherrod Brown, Marcy Kaptur and Stephanie Tubbs wrote in
a letter to the agency.

“It is imperative to establish a new fee schedule using rational
methodology … so that beneficiaries with [amyotrophic lateral
sclerosis] and other debilitating diseases that progress over time
will not be without the necessary mobility when they need it most,”
the Ohio representatives continued.

One of the largest power wheelchair manufacturers in the
country, Invacare Corp., is based in Elyria, Ohio.

In Pennsylvania, home of Pride Mobility Products, Sens. Arlen
Specter and Rick Santorum also asked HHS to postpone the fee
schedule.

In the Oct. 13 letter, the senators noted they had previously
warned CMS that reductions in excess of 12 percent could restrict
patients’ access to equipment. “We are concerned that the published
payment rates include reductions from 26 to 43 percent, which are
significantly higher than that amount,” the letter read.

The Pennsylvania lawmakers have been strong advocates for other
power mobility issues in the past, and most recently pushed for a
delay of the new power mobility codes and local coverage
determination, originally scheduled to take effect Oct. 1 (see
HomeCare Monday, Sept. 26).

In South Dakota, the state’s entire congressional delegation
sent a letter to HHS and CMS officials Wednesday saying they were
concerned that many providers in the state would not be able to
continue to supply PMDs after the new fee schedule takes
effect.

“Rural states, like South Dakota, face unique challenges in
ensuring that all Medicare beneficiaries have convenient access to
the array of benefits included in the Medicare program. One of
these challenges is the limited number of power mobility device
suppliers,” said the letter, signed by Sens. Tim Johnson and John
Thune and Rep. Stephanie Herseth.

One of the state’s largest providers, WestMed Rehab, said it
will no longer provide power wheelchairs to Medicare beneficiaries
after Nov. 15.

The Rapid City-based HME is the only provider of Medicare-funded
complex rehab technology services for 300 miles in any direction,
according to CEO Tim Pederson.

“Ten years ago we had three or four providers of these types of
services in western South Dakota. Today we are down to a single
provider,” said Pederson, who also is vice chairman of the American
Association for Homecare’s Rehab and Assistive Technology Council.
“At the very least we will need to be extremely selective about who
we choose to service. It may be that the only people who receive
these types of services are those who can afford to pay for them
out of pocket.”

The ITEM (Independence Through Enhancement of Medicare and
Medicaid) Coalition, a consumer-led group, also sent a letter to
HHS last week asking the agency to reconsider the cuts and for
clarifications to PMD Local Coverage Determination standards.

While the latest LCD says a beneficiary must be unable to stand
and pivot independently to qualify for a Group 3 device, many who
can–like those with multiple sclerosis, Parkinson’s disease and
cerebral palsy–still need a Group 3 device to complete activities
of daily living, ITEM said.