Similar Policy, Same Result

I am writing this column just prior to Medtrade, a time during which we are spending considerable resources to convince CMS to suspend the Oct. 1, implementation date of the new power wheelchair codes and fee schedules until CMS fixes their fundamental flaws. As the PSCs' Local Coverage Determination issued Aug. 15 stands today, those who have a need for a power mobility device after Oct. 1 will have serious problems obtaining the medically appropriate chair.

If, in the time between writing this and when you read this, CMS has rectified these issues, then we can all breathe a collective sigh of relief.

Just prior to a critical election for Republicans, the Bush Administration is taking a far-reaching approach, under the guise of preventing fraud and abuse, that will prevent many U.S. citizens from obtaining the clinically appropriate power mobility device.

The LCD issued in mid-August clearly will limit coverage of motorized wheelchairs and scooters to the cheapest and lowest-powered models. These Group 1 devices are not designed to be used by someone for more than two hours per day, are not designed for use on anything other than smooth surfaces and, in some cases, cannot even push up and over a door threshold.

The LCD also creates an even more meager benefit compared to one that has never been characterized as generous. Previously, Medicare did not pay for a power mobility device unless it was required for use indoors to eat, dress or use the bathroom. Despite those limits, the wheelchairs and scooters Medicare covered had the power and durability to be functional outdoors as well.

In the name of fighting fraud, CMS decided nearly three years ago to limit access to power wheelchairs and scooters to Medicare beneficiaries who could not walk a single step in their homes. An outcry from the public, and eventually Congress, pressured CMS to rescind this directive. Through various pricing, code and coverage changes over the past three years, CMS has essentially enacted a similar policy, taking a different route, with the same results: a downward trend in usage of the Medicare mobility benefit, resulting in a reduction in costs.

The technical changes scheduled to take effect Oct. 1 will mean that beneficiaries with mobility impairments will have to pay for an upgrade, which many can not afford. Otherwise, these consumers will be stuck with a wheelchair not designed to get them outside for any number of ordinary reasons, such as going to the mailbox, visiting a doctor, shopping for groceries or worshipping.