A message from the ITEM Coalition

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A message from the ITEM Coalition(Independence Through Enhancement of Medicare/Medicaid)In late August, Medicare issued a final local coveragedetermination (LCD) for power mobility devices (PMDs). The newcoverage policy had serious access implications for beneficiarieswith mobility disabilities. The new LCD implements a series ofnew payment codes for power wheelchairs and scooters, providingMedicare coverage for those devices with functional capabilitiesthat place them into either Groups 1 (lowest functioning), 2, or3 (highest functioning) PMDs.Essentially, the new policy had three major problems. First, thepolicy would significantly "downcode" the Medicare wheelchairbenefit placing many individuals into inadequate and often unsafepower wheelchairs. Second, the new policy requires that abeneficiary be unable to "stand and pivot" in order to qualifyfor the highest functioning chair - a standard that fails to takeinto account the functional needs of an individual. And third,the policy implements a new definition of the "in the home"restriction by denying access to wheelchairs that havecapabilities which are deemed unnecessary for indoor use.Many ITEM Coalition members expressed serious concern with thenew policy, calling for a rescission of the entire policy, an endto the downcoding, and the adoption of more functional-basedcoverage standards. On September 20, 2006, CMS released"clarifications" to the LCD that address some of the problemsidentified by stakeholders while leaving several harmfulprovisions in place.The LCD clarifications will alleviate some of the access concernsassociated with downcoding from Group 2 to Group 1 wheelchairs.This downcoding was of great concern because many individualswith disabilities would have been placed in inadequate and oftenunsafe mobility devices. Additionally, the clarifications delaythe implementation date of the LCD from October 1, 2006 toNovember 15, 2006. This delay allows clinicians and providersadditional time to become familiar with the coverage changes andanalyze the impact. CMS deserves credit fro these revisions.The "stand and pivot" standard, however, remains a major problem.The LCD states that in order to qualify for a Group 3 device, thebeneficiary must be "unable to independently stand and pivot totransfer due to a neurological condition or myopathy." However,there are many individuals with disabilities who may be able tostand and pivot but will need a Group 3 device to participate intheir daily activities.Finally, the clarifications do nothing to fix the new and morerestrictive interpretation of the "in the home" rule. The LCDstates that PMDs with capabilities not needed for use in the home(identified as Group 4 devices) will be downcoded to a Group 3device. Medicare currently covers wheelchairs that are needed byindividuals for use in their homes but has not preventedindividuals from using the devices outside of their homes.However, this new policy will not cover devices that havefeatures that are useful for out-of-home use.The ITEM Coalition Steering Committee sent a letter to HHSSecretary Leavitt as a response to the initial LCD (the letter isposted atwww.itemcoalition.org/press/pr/LeavittletterPMDLCD.htm).The Steering Committee will be following up with another letterthat thanks the Secretary for the recent changes and encouragesadditional changes to ensure access to the appropriate mobilitydevices for individuals with disabilities.We urge you to contact Members of Congress asking them to supportlegislation to eliminate Medicares "in the home" restriction formobility devices (S. 3677/H.R. 5983). Without enactment of "inthe home" legislation, Medicare will continue to utilize thisdiscriminatory coverage restriction to prevent access toappropriate mobility devices for people with disabilities. Youcan contact your Members of Congress via the Capitol switchboardtoll-free at 1-877-224-0041 or via email athttp://ga3.org/campaign/CommunityAccess.The LCD and clarifications can be found athttp://www.trustsolutionsllc.com/DRAFT_LCD_Status.asp.Please contact Niederman at the ITEM Coalition with anyquestions: (202) 349-4260. Thank you for your advocacy!__________________________________________________________For more healthcare news issues, see:http://www.aapd.com/News/health/indexhealth.php# # #