BALTIMORE--With less than a month to go until CMS' new fee schedule for power mobility devices takes effect, the American Association for Homecare said its Rehab and Assistive Technology Council sent a letter to HHS Secretary Michael Leavitt and CMS staff last week asking for a delay.

The new pricing, issued Oct. 2 and scheduled to be implemented Nov. 15, cuts reimbursement by more than 40 percent for some equipment (see HomeCare Monday, Oct. 9). As a result, stakeholders said that it will be difficult for providers to remain profitable in the rehab business, and some are now warning that layoffs are inevitable.

"We [believe] that the new payment levels are far too low to support appropriate access to PMDs for Medicare beneficiaries, especially in light of the new coverage, documentation and quality standards that suppliers will be required to meet," the letter said, noting that the new fee schedules "significantly undermine the progress CMS has made to date in these other areas and pose what may be insurmountable barriers to access for Medicare beneficiaries."

The letter adds that the delay would give CMS the opportunity to work with stakeholders to come up with payment amounts that are "realistic and equitable" using the data and analysis from a Muse & Associates study presented to CMS earlier this year.

The study, which was commissioned by AAHomecare, pointed out problems with CMS' gap-filling methodology for setting fees (see HomeCare Monday, Sept. 19, 2005).

Patient and beneficiary advocacy organizations also are mobilizing to fight the new cuts. Last week, a statement from the American Association of People with Disabilities, the Clinician Task Force and the Independence Care System lambasted the PMD fee schedule. "Already, many suppliers from around the country say they will stop providing mobility equipment or go out of business because the Medicare reimbursement payments will be too low to cover the cost of acquiring the chair, fitting the patient and servicing the equipment," according to the statement.

"This is an intolerable situation that amounts to dismantling an important Medicare benefit for senior citizens and people living with disabilities," said Andrew Imparato, president and CEO of the American Association of People with Disabilities. "There will be a loud and powerful outcry. CMS won't be allowed to turn back the clock on providing a critical piece of medical equipment for people who need mobility assistance."

"We cannot allow CMS to let these vast policy changes stand," said Laura Cohen, co-coordinator of the Clinician Task Force. "Clinicians, physicians and advocates for senior citizens and people living with disabilities will be asking Congress to intervene and ensure that the elderly and some of the most vulnerable people in our society can obtain necessary mobility equipment through the Medicare benefit."

Meanwhile, some are predicting that the deep power mobility cuts could result in layoffs.

"The bottom line is that we won't be able to service the custom wheelchair market anymore without Medicare retracting this new fee schedule," said Jim Greatorex, president of Portland, Maine-based Black Bear Medical, which said in a statement last week that layoffs are likely under the new fee schedule.

Greatorex said he fears that private insurance companies, which often look to Medicare when creating their own policies and fees, will insist on similar cuts.

"There has been a concerted effort by CMS over the last three years to dismantle the Medicare mobility benefit," he said. "In the past, we have politely worked with them to make their policies reasonable. But now we are taking gloves off. It is time to play hardball. These price cuts go far beyond what anyone could consider reasonable."