Monday, April 28, 2014
WASHINGTON (April18, 2014)—As reported by AAHomecare, Dorena Hyatt of Meyersdale, Pa., has been disabled since the age of 12. “My disability affected my legs and I am no longer able to walk,” said Hyatt. Now 65 years old, she lives alone and maintains her independence by using a power wheelchair. A component on Hyatt’s chair recently broke, causing the electric unit to hang off the frame. But getting her chair fixed proved to be a bigger problem than it should have been. “After talking to my durable medical equipment supplier I was told that they could not replace certain parts without physically going to a doctor to get a prescription to fix the part. It took two weeks to get an appointment, and it was well over two weeks that I had a malfunctioning chair,” said Hyatt. “Living in fear that the chair could malfunction at any time, knowing I could not perform my daily activities was a horrible burden.” Yet, Medicare required Hyatt’s doctor to reevaluate her need for the chair and confirm that the chair was broken. So, she had to find a way to get to her doctor’s office before her medical equipment supplier could make repairs. On the day of her doctor’s appointment, Hyatt took her broken, unsafe chair on public transportation, which is infrequent where she lives, for her face-to-face exam. “In the middle of winter, the ice and snow on the sidewalks and streets potentially put my life in danger. And the chair could have stopped functioning at any point to or from the doctor’s office,” said Hyatt. “I consider the doctor's appointment to be an unnecessary step because the doctor did not provide the chair to me, nor does the doctor perform maintenance on the chair. Having to go to the doctor was an unbelievable burden to me because I did not trust the chair and it added too much time to getting the chair fixed in a reasonable manner,” Hyatt explained. “Would you want a family member to go through this? I am a grandmother with a disability who is desperately fighting to keep her independence, and laws like this do not help disabled citizens. Change the laws.” Although the Centers for Medicare and Medicaid Services required face-to-face exams for certain products prior to passage of the Affordable Care Act, these requirements were expanded in the new law. As of April 1, a face-to-face exam must be performed within six months of a prescription for the following:
  • All claims for purchases or initial rentals
  • When there is a change in the prescription for the accessory, supply, drug, etc.
  • If a local coverage determination requires periodic prescription renewal (i.e., policy requires a new prescription on a scheduled or periodic basis)
  • When an item is replaced
  • When there is a change in the supplier
  • When required by state law