Swift Support Needed to Delay Elimination of First-Month Purchase Option

WASHINGTON — Two congressmen are working to put the brakes on elimination of the first-month purchase option for power wheelchairs through a sign-on letter, but there is less than two weeks to generate support.

Reps. Jim Langevin, D-R.I., co-chair of the Bipartisan Disabilities Caucus, and Glenn Thompson, R-Pa., are leading the congressional charge to delay elimination of the option for a year. Mandated under the health care reform law, the measure currently stands to be implemented Jan. 1, 2011.

The target date for the congressional letter, to be sent to the chairmen and ranking members of the House Ways and Means and Commerce committees, is Friday, Sept. 17.

“The industry needs to remain focused on reaching out to legislators to educate them on why a delay in implementation is necessary in order to preserve access to these products and services and local jobs,” said Seth Johnson, vice president of government affairs for Exeter, Pa.-based Pride Mobility Products. “We now have a letter to formally quantify the level of support for the delay in the House, and a similar letter is expected to be circulated in the Senate soon.”

With elimination of the purchase option, mobility providers would have to wait for 13 months before being fully compensated by Medicare for a standard PWC (complex rehab chairs are exempt). Payment in months one-three would be 15 percent of the purchase price and 6 percent in the remaining 10 months. Hamstrung by the floundering economy, which has basically caused financing to dry up, most providers cannot make the sizeable cash outlay upfront that a power wheelchair demands.

Without a delay, Langevin and Thompson point out, “this policy will create significant access and quality-of-care issues as providers of this equipment either struggle to make the significant changes to their business model to adapt to a new payment model that has the costs front-loaded with reimbursements from Medicare spread over 13 months — or simply go out of business.”

A one-year delay would allow providers to build up their rental fleets and transition to the new system, the representatives note.

“Delaying implementation of this provision for one year will give power wheelchair providers a much-needed transition period to secure additional financing and adjust their business models so that consumers will not see interruptions or reductions in access to services,” reads their letter to colleagues about the situation.

The letter suggests the delay, estimated to cost less than $50 million, could be paid for by a 1 percent reduction to the Consumer Price Index update to standard PWCs. Some stakeholders believe such a delay might even be supported by CMS.

“We believe CMS is also open to a delay so they can make the changes that are needed to implement this plan, and in a way that is not going to jeopardize beneficiary access,” Johnson told HomeCare earlier. He said Friday the hope is for the delay language to be inserted in legislation prior to Congress’ adjournment.

Johnson said a Medicare doc fix bill, which would remedy a steep cut in physician reimbursement, is the primary vehicle that has been identified for inclusion of the delay language, “but we have been told there will be other opportunities as well.”

One of the other opportunities, he said, could be what is known as the “extenders bill,” which covers certain tax provisions set to expire this year and for which there is broad bipartisan support to extend. That bill must be passed by Sept. 30.

Johnson said stakeholders including the American Association for Homecare are actively courting not only providers but also consumers and clinicians and urging them to educate their representatives on the issue.

Already, several advocacy organizations have voiced support for the delay, including the American Association of People with Disabilities, Association of Programs for Rural Independent Living, National Council on Independent Living, National Spinal Cord Injury Association, Paralyzed Veterans of America and the United Spinal Association.

Read the complete sign-on letter on the AAHomecare website.