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.