Q. The electric wheelchair I’ve been using the last 10 years is beyond repair, and my vendor says replacement parts are unavailable. My need for the wheelchair is critical. I have multiple sclerosis, am partially paralyzed on one side of my body, can stand and walk short distances but no more than a few feet without assistance. Limited arm function on one side makes it impossible to push a manual wheelchair.
My previous wheelchair, apparently classified as complex rehab technology, provided tilt and recline functions and a joystick, so I stayed in the chair from morning until I went to bed at night, except for short periods. I could also transfer to my couch if I needed a major shift in position or rest.
Now I have learned that my level of disability does not allow me to have a chair with the same features. I have been “demoted” to a standard power wheelchair.
I am expected to rent this equipment and make payments on it for over a year before it is considered my property. If something happens to me and I am unable to make a payment, I worry that they would repossess the chair and leave me without a mobility device. With all of the changes in Medicare the past few years, I had hoped things would get better. The process of obtaining a replacement wheelchair has been extremely time consuming, frustrating and I still don’t understand the reasoning behind it. Can someone explain what is happening to the process and why? Renting wheelchairs seems like a very cumbersome process that is more costly to administer than dealing with purchases one time. What is behind all of this?
— Not walking, I need to roll
A. Congress mandated changes to Medicare policies regarding durable medical equipment, which includes your wheelchair, as part of a broader fraud prevention and cost saving measure. The Medicare insurance program has been the target for fraud and abuse for many years, especially involving three-wheeled scooters, which has resulted in billions of dollars of excess costs. Congress tasked the Centers for Medicare and Medicaid Services with new laws to devise programs for lowering costs and providing additional oversight. Those laws expanded and made permanent a cost-saving program (competitive bidding), which changed the amount Medicare will pay for certain DME, prosthetics, orthotics and supplies. Since CMS reported saving approximately $2 billion in the most recent reporting year for this program, competitive bidding may remain in place even though it is unpopular among vendors and many end users.
You have several options if you are dissatisfied with what is happening in regard to your next wheelchair. The first step before ordering the chair requires a prescription from your physician, followed by a joint evaluation with an assistive technology professional and a qualified therapist. That team has fairly strict guidelines regarding eligibility, based solely on your capabilities and disability type. If you disagree with their findings, you can request a secondary evaluation in hopes of getting upgraded to a CRT wheelchair. This must be done prior to ordering.
Be sure that your request is extremely detailed. Additional correspondence from physicians familiar with your specific disability should be included if they agree that you need more complex equipment. Remember, Medicare still pays only for equipment meant to be used “in the home” (many advocates believe this is an arcane regulation that needs to be changed).
Renting your manual or standard electric wheelchair is just one option. Your supplier should also give you the opportunity to purchase outright with a 20 percent copayment as in the past. After paying, you own the wheelchair and will be responsible for paying coinsurance for any maintenance on it. If you decide to rent to purchase, that down payment would be broken into 13 installments that would be paid monthly; the first three payments would be slightly higher than the last 10. During that time any repairs or maintenance of the equipment would be the responsibility of the supplier. You would own the wheelchair after 13 months.
Each individual has unique needs, so it is important to get specific answers before proceeding rather than relying solely on this general information. The Medicare website lists participating vendors in your region. You should follow up with them to discuss all options.
Fraud has been reduced and savings realized. But the complexity associated with additional paperwork requirements and scrutiny of each DME purchase has created a cumbersome and flawed system for end users. Congress is still considering additional items to include in competitive bidding, which will create even more paperwork for vendors at a time when their reimbursement rates have been reduced and large numbers of vendors have already been driven out of business.
It is important to contact your congressional representatives if you are concerned that this program is not working properly.