First-Month Power Wheelchair Purchase Elimination Still in Play

WASHINGTON — In the House version of the much-debated health care reform bill, elimination of the first-month purchase option for standard power wheelchairs is still in play, although complex rehab chairs in Group 3 or higher would not be affected.

According to Seth Johnson, vice president of government affairs for Pride Mobility Products Corp., Exeter, Pa., the Senate continues to work on its health reform bill, which, so far, also includes elimination of the purchase option for standard PWCs, albeit in a somewhat softened provision.

“The Senate version would front load payments, so 45 percent of the total is received within the first 90 days,” said Johnson. “Even with the front-loading of payments, that still falls well short of the amount necessary to cover all the costs of providing a physician-prescribed power wheelchair.”

In response, the American Association for Homecare‘s Complex Rehab and Mobility Council (formerly the Rehab Assistive and Technology Council) has developed an alternative dubbed the “claw back” provision that would preserve the first-month purchase option. However, upon notification by CMS, providers would be required to refund Medicare the difference between the purchase amount and what would have been paid under a 13-month rental for any beneficiaries whose medical need ends prior to the 13th month.

In other words, for beneficiaries who don’t use their wheelchairs for a full 13 months, CMS could view the purchase as a rental and ask for its money back for the time the chair was not used.

“While this alternative is not perfect, it does preserve the purchase option and provide an opportunity to manage through the change,” Johnson noted. “A straight elimination of the purchase option provides no such opportunity.”

Added Tim Pederson, CRMC chair, “We don’t have great choices with this situation. If we are to choose between the ‘claw back’ provision and a straight 13-month rental for motorized wheelchairs, then of course this is a better choice.”

The alternative would have “minimal impact” on most providers, Pederson said, “because around 90 percent of power wheelchair users are still using their wheelchairs post-13 months.

“This preserves the complex rehab provider’s ability to continue to offer the full spectrum of power mobility,” he said.

Things are quieter today on Capitol Hill now that representatives have left town for their traditional August recess. The Senate is scheduled to follow this week.

For those on both sides of the health care reform debate, Congress’ summer break is another opportunity to scrutinize the House and Senate bills, which are still being negotiated. The Energy and Commerce Committee — one of three in the House with jurisdiction over health reform — passed its bill late Friday, but differences in its draft and those of the Ways and Means and Education and Labor committees must be reconciled. The Senate Finance Committee also had been expected to unveil its health reform bill Friday, but that didn’t happen.

So while Congress will return to work Sept. 8, advocates say now is the best time to meet with lawmakers in their home offices.

“We are encouraging all stakeholders to utilize the month of August,” stressed Johnson. “Meet with legislators in your home state or district and continue to convey the impact that a purchase option elimination will have on constituents.”