One of the principal goals of health care reform was to improve access to medical care and services, particularly for the most vulnerable in our society — the poor, frail, elderly and those living with disabilities. So it's unfortunate and ironic that some new policies, including provisions in the health care reform law, have instead made it more difficult for Medicare patients to receive the mobility assistance that can help them remain at home living safely and independently at a lower cost to our health care system.
Policymakers often overlook the value of power wheelchairs to patients with mobility impairments. Most take mobility for granted. But a power wheelchair can be the key factor that allows Medicare beneficiaries to remain in their homes.
Mobility providers have suffered a long string of obstacles and setbacks: the steep Medicare reimbursement cuts in recent years, implementation of the problematic bidding program, excessive and overreaching audits, confusing and inconsistent guidelines for documenting medical necessity and elimination of the first-month purchase option, among others. Mobility providers across the country say they now must determine whether it makes sense from a business perspective to continue providing power wheelchairs to Medicare patients.
We occasionally make progress. In April, the DME MACs allowed use of Advance Beneficiary Notices (ABNs) for Group 2 power operated vehicles and Group 4 power wheelchairs so that consumers can elect upgrades that best suit their needs. The previous policy had the unintended consequence of classifying these items as “non-covered” by Medicare, which meant that beneficiaries would have had to pay the full cost of these items since an ABN cannot be used for non-covered items.
The American Association for Homecare, National Coalition for Assistive and Rehab Technology, National Registry of Rehabilitation Technology Suppliers and other groups engaged CMS and the DME MAC medical directors seeking revisions to this policy so that Medicare beneficiaries would continue to have access to these products and related services. Still, there are numerous burdens.
Many providers now struggle when repairs are needed. In the past, Medicare fairly reimbursed providers for repairs, but the reimbursements have been slashed to the point that providers often lose money when fixing power wheelchairs for Medicare patients. As an unintended consequence of these policies, it's getting harder for providers to supply the equipment and services that Medicare beneficiaries need.
Recently AAHomecare surveyed more than 125 mobility providers across the country to learn how companies are adjusting to these Medicare policies. Many providers reported negative consequences such as no longer offering power wheelchairs or going out of business. The survey found that:
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65 percent said their ability to service Medicare beneficiaries has been compromised;
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48 percent said their repair policies have been negatively affected; and
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28 percent said their level of staffing has been cut.
In addition to addressing the regulatory challenges that providers face, mobility stakeholders have been pushing for federal legislation that would create a separate benefit category in Medicare for complex rehab technology. The current Medicare HME benefit does not adequately differentiate complex rehab technology and the required, related services, and fails to adequately address the needs of individuals with disabilities, consider the range of services furnished by complex rehab technology companies and incorporate the complexity and unique nature of the equipment itself.
Stakeholders working together on the separate benefit include the Clinician Task Force, NCART, NRRTS, the Rehabilitation Engineering and Assistive Technology Society of North America and United Spinal Association as well as AAHomecare.
HME professionals are committed to helping people living with disabilities to improve their quality of life. When Medicare policies create obstacles to care, the HME community needs to work together to fix the problems through regulations or legislation. AAHomecare accepts this challenge each day, and we welcome your support and assistance.
Read more AAHomecare Update columns.
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.
