The Centers for Medicare and Medicaid Services (CMS) have proposed a new coverage policy and fee schedule for powered mobility devices (PMDs) that will prevent some severely disabled Americans from accessing the medically-appropriate power wheelchairs they need to live safe, independent and productive lives.
Under the new coverage policy to take effect November 15th, only persons with a neuromuscular or neurological condition who cannot perform a stand, pivot, and transfer test will be eligible for a higher-performing wheelchair. Those who can perform the test will be forced into other technologies, many of which lack critical features needed by people battling diseases such as ALS, multiple sclerosis, and cerebral palsy.
Also threatening access is the proposed fee schedule which cuts reimbursements for higher-performing chairs by an average of 30 percent. For some chairs, the reimbursement will not even cover the suppliers’ acquisition cost. The proposed fee schedule further ignores the service costs associated with fitting and configuring a complex device to be used by a severely disabled person. We believe this fee schedule is certain to put many suppliers of complex rehab equipment out of business and further hinder access to equipment needed by the disabled.
Experts in the rehabilitation industry, including clinicians and equipment suppliers, are urging CMS to rescind and modify this coding and fee schedule before they take effect and hurt disabled Americans.
“Without these higher-performing chairs, many beneficiaries will lose much of the independence and mobility they currently have and either be forced into nursing homes or require the assistance of another person for activities they can currently do independently,” said Rita Hostak, NCART president.
The National Coalition for Assistive and Rehab Technology (NCART) is asking CMS to:
• Postpone the November 15, 2006 PMD Fee Schedule and Local Coverage Determination (LCD) in order to resolve all identified issues.
• Establish a new Fee Schedule using a rational methodology, accurate product classifications and pricing data.
• Recognize the service component inherent in providing higher-performing wheelchairs to persons with disabilities
• Make necessary changes to the Local Coverage Determination to eliminate the stand, pivot, transfer requirement and allow for recognition of the progressive nature of some disabilities.
Sharon Hildebrandt works for The National Coalition for Assistive and Rehab Technology (NCART) www.ncartcoalition.org