Roll Call Ad Asks Congress, HHS to Delay PMD Changes

WASHINGTON–Twelve organizations representing people with
disabilities signed an advertisement in Capitol Hill newspaper
Roll Call Thursday urging Congress and HHS to delay
implementation of a power mobility device policy that they say
would force Medicare beneficiaries into inadequate power
wheelchairs and scooters.

“HHS secretary and members of Congress, stop implementation of
this harmful policy!” read the ad, which was signed by members of
the Independence Through Enhancement of Medicare and Medicaid
(ITEM) Coalition including: the American Association of People with
Disabilities, Amputee Coalition of America, The Arc of the United
States, Christopher Reeve Foundation, Medicare Rights Center,
National Council on Independent Living, National Multiple Sclerosis
Society, National Spinal Cord Injury Association, Paralyzed
Veterans of America, Rehabilitation Engineering & Assistive
Technology Society of North America, United Cerebral Palsy and
United Spinal Association.

For months, stakeholders have raised concerns about the new PMD
codes and other changes that CMS intends to implement by Oct. 1.
The most recent controversy surrounds the power mobility local
coverage determination released by the DME contractors (see
HomeCare, Aug. 21).

The LCD, which incorporates the 64 new codes and includes
coverage criteria, identifies a number of situations in which a
“least costly alternative determination” may be made.

Clinicians and HME advocates maintain that such downcoding will
restrict Medicare beneficiaries to inexpensive, low-powered models,
leaving people with diseases such as multiple sclerosis,
Parkinson’s disease or cerebral palsy in the position of no longer
qualifying for a power chair appropriate for their current and
future medical needs.

“What CMS is doing is wrong,” said Henry Claypool, an advocate
from the coalition. “We need for Congress to hold CMS accountable
for this attempt to further restrict access to power wheelchairs in
a fashion that undercuts the physician’s role in determining which
wheelchair will best promote the health and independence of those
with Medicare.”

Claypool added that under the new policy, many beneficiaries
will be restricted to power wheelchairs and scooters that can only
be used in their homes and “in some cases, may confine them to
specific rooms in their homes because they cannot maneuver over
door thresholds.”

This, according to Andrew Imparato, president and CEO of the
American Association of People with Disabilities, could endanger
the lives of disabled seniors if their mobility equipment doesn’t
allow them to flee an emergency in their home. “Essentially,
Medicare will be making beneficiaries prisoners in their own
homes,” he said.

Although current Medicare policy officially restricts coverage
of powered equipment to in-the-home use, up until now,
beneficiaries have been allowed to receive power wheelchairs that
could also be used outdoors, allowing them to leave their homes to
go shopping, visit doctors or take part in community
activities.

Laura Cohen, a co-coordinator of the Clinician Task Force, said
CMS’ new guidelines must be changed because they do not address the
functional needs of patients, which should be the foundation for
the coverage policy. “Their approach is based on cost-cutting
standards that require individuals to be completely non-ambulatory
to receive an appropriate mobility device,” she said. “These rules
will undoubtedly force many beneficiaries into inappropriate and
low-functioning mobility devices. And that is not in the best
medical interest of these individuals or fiscally responsible to
taxpayers.”

In recent letters to CMS and HHS, Sens. Arlen Specter and Rick
Santorum and Rep. Don Sherwood, all Pennsylvania Republicans, asked
CMS to delay the implementation and make significant changes in the
guidelines on coding, pricing and coverage policies for the medical
equipment.

Sen. Santorum “strongly urged” that implementation be postponed
until January “so that access to medically appropriate equipment is
not compromised.”

Rep. Sherwood said that the recent changes “will create major
disruptions to the power mobility industry and result in denial of
coverage in appropriate devices.”

And Sen. Specter urged CMS to rectify problems raised by
stakeholders, and that CMS then provide a 45-day comment period and
a 45-day notice period followed by a 90-day transition period.
“These adjustments,” he said, “will provide for a transition period
for new codes, pricing and coverage policies that will allow for
appropriate education and adaptation to the significant
changes.”

AAHomecare’s Rehab and Assistive Technology Council also sent a
letter Tuesday to HHS Secretary Mike Leavitt and CMS Administrator
Mark McClellan requesting a delay.

“We believe the policy as currently written contains significant
health and safety concerns and we strongly recommend that CMS
postpone implementation until these concerns are addressed and a
revised LCD is issued that ensures access to medically appropriate
equipment,” the letter stated.

To view the LCD, click here.