First, please read my other entry from today since it explains there isn’t actually a set-in-stone health care reform bill. Second, THANK YOU for all the comments and e-mails on this topic.

This entry specifically addresses a comment on my August 7 entry. I was referred to a section of the combined House bill that redefines power wheelchairs as complex rehab. Complex rehab’s been a bit of a buzz term, since many of us have been working on getting a complex rehab carve out from the horrible CMS competitive bidding program, so redefining power wheelchairs in and of itself isn’t a problem.

But our readers are the smartest in the world and so I knew there was more to the comment. I asked Michael Reinemer, vice president for communications and policy of the American Association for Home Health Care to explain to me why that comment could be a harbinger of trouble.

“I believe that provision eliminates the option for beneficiaries to buy their wheel chair during the first month of use in Medicare,” says Reinemer. Or, more specifically,“The healthcare reform bill, HR 3200, maintains the purchase option for group 3 power wheelchairs and above, but eliminates the purchase option for standard power wheelchairs.  Maintaining the current policy of allowing beneficiaries to purchase the equipment in the first month ensures appropriate access to equipment and lower costs to consumers and the Medicare program.”

Here’s how Reinemer says this affects wheelchair users and providers:

     * Many power wheelchairs are custom-configured for the user and are not commodity-type items.

    * Forcing the rental of custom-configured power wheelchairs will severely curtail access due to the significant up-front costs that the provider must be able to cover soon after delivery.

    * Providers will not have access to the capital or lines of credit needed to wait 13 months to receive full payment.  Given the current economic climate, this problem becomes more significant.  Providers who are unable to obtain financing will be forced to lay off employees and close their businesses and they will not be able to offer customized chairs to meet a beneficiary’s specifications.

    * Over the past two years, power wheelchair providers have seen significant increases in set-up, delivery, and documentation costs due to the face-to-face examination requirement and other new coverage policy requirements, in addition to the cost of accreditation and surety bonds. At the same time, reimbursement was cut an average of 27 percent in 2006 and an additional 9.5 percent effective January 1, 2009.

    * The average Medicare fee schedule payment for a “Group 2 Standard Weight with Captain Seat” (HCPCS code K0823) is $3,641.40.  By eliminating the beneficiary’s purchase option and requiring power wheelchairs to be rented over a 13-month period, the total rental payment would be $3,823.52.  The Medicare program would pay 5 percent more for power wheelchairs under the rental option.

The American Association for Homecare has been working to preserve the first month purchase option in by working with members of Congress on this issue and other issues related to access See www.aahomecare.org.

Keep those comments, e-mails and phone calls coming! And more importantly, talk to your legislators. The ball, God help us all, is in their court.

Outstanding Columns Josie! This topic is vital to our health and mobility! When you consider wheelchair user's issues like seating, positioning, avoiding pressure ulcer issues, potential shoulder problems, etc.; having the correct wheelchair--power or manual--is literally a matter of life and death! A great resource that will help people understand and navigate the political side of things, as well as a guide to find out how to get fitted for, and reimbursed for the correct chair is NRRTS, "National Registry of Rehabilitation Technology Suppliers". Their website is: www.nrrts.org

Please check out this new SCI News Blog: http://sci-news-blog.blogspot.com/

You only present half the story. Here are the facts. 1. AA Homecare is a lobbying group for HME dealers. Of course they want more Medicare money. 2. People with perminant disabilities can, do and will continue getting power wheelchairs. Your readers don't need to worry. 3. The Group 2 standard power wheelchairs are not custom as you say, but are standardized products (that's why they are called standard). These are the type of wheelchairs that the elderly get through Medicare and either don't use them or pass away. Look on ebay or craigs list where they are regularly sold for cash. This is a very wasteful part of Medicare. These scooter shop type of products aren't used my many but sold by the hundreds of thousands to only profit dealers. 4. Standard manual wheelchairs are rented just like the proposed plan and it works well. 5. This plan saves tax payers money and allows more credibility for full time power wheelchair users to get the equipment they really need.

Hello, Well just today at my job which is a leading DME company in the USA, it was told to us the as of today that Region C was changing the requirment in obtaining a powerwheel chair. We had a form that the physican completed (medicare criteria required questions)and now that form is no longer accepted. With this being said all information now must be obtain in a letter of medical neccesity. This not only provided that information but other information about the patient that was used in reviewing the claim for a powerwheel chair. We are having to restructure our department to accomidate these changes. As my Supervisor reassured me and other we will survive this. I know that with this change it will make it that much harder for our company to help these patients that really need it. Thank you for your listening ear. SZ

They need a raise so they cut our legs the wheel chair right out from under us.

I am in the middle of this right now. Because of the changes my current power chair company has had to make major differences to their chair. When they delivered the new one I was expecting the same chair. What I got was the new version, with major changes to it. I was expecting the same type of seating and it was not there. When you have to either sit or lie down, the comfort of your chair is the most important.

Our wheelchair user (Cerebral Palsy Spastic Quad) has driven an Invacare for years. She presently has an Invacare Storm TDX3 with ASL head array and toggle switch. Her CP related spasticity is quite severe and probably at its worse now. Never one to be pushed in a manual chair before she is now opting to use her backup stroller on a daily basis instead of the powerchair. The vendor says there isn't anything else they can do except order a manual chair. I say no. This will eliminate her possibility for independent mobility just when she needs it most. She is 19 years old and attends school. The school aides don't want to bother with the powerchair. (It had electronic problems in the past but not now). The Invacare powerchair has been the only one we have had that she could drive well. We had a Jazzy for a while and it was a nightmare. The vendor we use is in Memphis, TN and has given good customer service on repairs. Any suggestions?

TheSameStory is correct-boycotting Competitive Bidding by curtailing services to people who need power chairs, oxygen, vents, etc but have a LOMN, and their doctor's RX has gone on since 2008. This is planned to "nudge" to bring public outrage on their side. Civil suits may be filed against vendors who play patients along without providing what their doctors are ordering. We've been working with people in our region who have lost their independence, and some carrying their ABDs in their old power chairs, plus extra batteries to merely be able to be transported to doctor appointments, and PT, etc. The disability community is getting fed up. Interference between people and their physicians won't be tolerated for long. The HME lobbying groups had better realize that every intelligent company utilizes competitive bidding, or they won't be in business very long.

The question must be asked how can "we" expect non-medically licensed salespeople to be medically ethical? Thus, they lobby against health care reform to maintain their for-profit bottom line, that's the role of for-profit companies, and suppliers, making investors happy, not their TARGET population. The NRRTS is skewed and not toward the disability populace, other than lining their members' pockets; listen to the audio - professional? Not. When insurers/CMS purchases all DME directly from the manufacturer, and utilizes regional medical centers for eval., assessments, delivery, teaching, et al, no jobs will be lost (same # people required), but transparency will exist; however, lobbyists will have to find another pasture.

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