Our industry faces the recurring threat in Congress to eliminate a patient's option under Medicare to purchase a power wheelchair during the first month of its use.
Persistent threats, however, have strengthened our resolve and helped build a strong coalition among consumers and providers. Through this alliance-building, AAHomecare hopes combined efforts may produce long-lasting advantages as well as near-term wins for disability groups and the home care community.
The president's Fiscal Year 2008 budget, proposed in early 2007, included a provision eliminating the opportunity for Medicare beneficiaries to purchase a power wheelchair when it is initially prescribed by a physician. The threats became more real over the summer when the House passed its version of a bill relating to reauthorization of the State Children's Health Insurance Program.
As of press time, the president had vetoed the SCHIP measure (without any Medicare provisions), but this is only a temporary victory. Threats to the first-month purchase option for power wheelchairs are certain to emerge again.
Along with the American Association for Homecare, seven consumer advocacy groups are voicing opposition to change of the power wheelchair policy. These groups include the American Association of People with Disabilities, the ALS Association (Lou Gehrig's disease), Easter Seals, the National Council on Independent Living, the National Spinal Cord Injury Association, the Paralyzed Veterans of America and the United Spinal Association.
Eliminating a patient's first-month purchase option would force the beneficiary to rent the power wheelchair for 13 months before ownership transfers to the patient. Elimination of this option will reduce access to those wheelchairs for beneficiaries who live with long-term conditions such as multiple sclerosis, Lou Gehrig's disease and spinal cord injuries.
A “rental-only” policy will create severe access problems because providers will be unable to cover the significant up-front costs needed for the power wheelchair. They also will be unable to produce the needed specialized items and related services such as the custom accessories including custom backs, seats and tilt/recline systems required for power wheelchairs.
Most Medicare beneficiaries who require power wheelchairs live with long-term debilitating conditions that are not short-term in nature and, with few exceptions, use such a chair for the remainder of their lives. Once prescribed a power wheelchair, virtually all of those Medicare beneficiaries elect to purchase within the first month.
Marcie Roth, executive director and CEO of the National Spinal Cord Injury Association, says the changes in policy contradict the president's New Freedom Initiative and contradict the widespread support for access to services and supports to maximize function and independence.
“In fact, in addition to driving up cost, this provision may well lead to violation of the civil rights of individuals with disabilities to live in the most integrated setting appropriate, since successful community living is often dependent on the availability of assistive technology that would be denied under this provision,” Roth says.
An American Association for Homecare analysis has shown that eliminating the first-month purchase option would result in the Medicare program paying 5 percent more for power wheelchairs than Medicare currently pays.
Consumer groups and home care providers will continue to lobby for Medicare beneficiaries' ability to retain the first-month purchase option. We understand threats to the home care industry will continue to resurface, including a number of critical issues that may be introduced in Congress this fall.
AAHomecare will continue to work with consumer advocacy groups to advance the intents of the home care community, and we recommend this strategy for providers and other stakeholders at local and state levels. A coalition of organizations increases the likelihood of success, brings more expertise and resources to the table and helps put the patient front and center.
Tyler J. Wilson is president and CEO of the American Association for Homecare, Alexandria, Va. He may be reached by e-mail at tylerw@aahomecare.org. For more information about the association, visit www.aahomecare.org.
