This summer, our nation celebrates the 20th anniversary of the Americans with Disabilities Act. For the home medical equipment community, it's important to recognize the opportunities that ADA has created for millions of people, and at the same time, we need to focus attention on the battles still being fought on behalf of Americans living with disabilities.
More than 54 million Americans have physical or mental impairments that substantially limit daily activities. They are protected under the ADA, and many receive equipment and care from the HME community.
Congress and the Medicare program, which serves this population, have adopted a number of policies that are making it more difficult than ever for Medicare patients to receive vital home medical equipment and services. Appropriate medical equipment and related services are essential for Medicare patients seeking to remain healthy and independent rather than being placed in nursing home or other institutions.
But misguided programs and policies in Medicare — such as the “competitive” bidding program and elimination of the first-month purchase option for power wheelchairs — will hamper patient access to care. The best illustrations of what's at stake come from power wheelchair users and others who are on the front lines of the HME community.
“I am worried about the impact of competitive bidding,” says Lucy Spruill, director of public policy and community relations for United Cerebral Palsy of Pittsburgh. Spruill, who has spina bifida, knows firsthand about the importance of access to adequate equipment and care. “It will reduce the number of DME providers, which is already insufficient to meet the demands of power mobility. It will increase the likelihood that patients will get the cheapest rather than most appropriate mobility device, which will lead to difficulty using the equipment, health problems, decreased activity and safety issues.”
A wheelchair user, whose story was shared with Congress and the media through AAHomecare's Mobility Matters bulletin, illustrates another part of the challenge. The user sought a power wheelchair from Medi-Source Equipment & Supply, an HME provider in rural Yucca Valley, Calif. Both his legs had been amputated, and after a stroke he had the use of one “good” arm that constantly ached.
His power wheelchair was broken and lay crumpled on the side of his caregiver's garage, which also served as his home. Under Medicare regulations, Medi-Source Equipment & Supply provided the wheelchair before filing the reimbursement claim. The original claim was denied. Medi-Source appealed, documenting the user's unique situation — he was literally living in his chair, sometimes 24 hours a day, and was staying in a friend's garage.
Not only was the appeal denied, but the case was referred to Medicare's patient culpable neglect unit. The user was investigated for allegedly abusing his original wheelchair and was in danger of having his Medicare benefits restricted.
So the Americans with Disabilities Act, the world's first declaration of equality for people with disabilities, should serve as a reminder and inspiration. We need to remind the public and policymakers about the independence we help to preserve but also continue to educate Congress and CMS of the access problems that still exist.
“The establishment of the ADA has led to a better understanding of the very real challenges that people with disabilities continue to face,” says Jackie Semrad of Reliable Medical Supply in Brooklyn Park, Minn. “We have come a long way over the last 20 years! We must continue to advocate for our patients.”
To contact your members of Congress or the media about the importance of home medical equipment and services, visit the Action Center at www.aahomecare.org.
Read more AAHomecare Update columns.View more competitive bidding stories.
Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. You can reach him at tylerw@aahomecare.org. For more information on critical home care issues, visit the association's Web site at www.aahomecare.org.
