September 7, 2006 .
Editor’s Note; There are a number of links within this article all relating to the history of the decision to be implemented on Oct. 1.
Steve Hoad

(reproduced with permission of the Medicare Rights Center, http://www.medicarerights.org )

Starting October 1, many people with Medicare who need a power wheelchair will be in trouble. Under new rules set to go into effect, people in need may only be able to get wheelchairs that are next to useless, and potentially dangerous, outside their homes.

This is because the Centers for Medicare & Medicaid Services (CMS) plans to implement new standards for what kind of power wheelchairs to cover. It is a shift in policy that should be stopped.

The new policy adds a cruel twist to an already skewed coverage policy for wheelchairs. CMS believes that Medicare should not cover a power wheelchair for someone who needs one outside the home but can get around inside their houses or apartments. This policy springs from a misreading of the law: most people who need a power wheelchair can make the case that they need it both at home and outside, so the CMS policy has had limited impact.

Until now.

Unless they require special seating, people needing a power wheelchair will only receive coverage for what many wheelchair users call a "junk wheelchair," a device that has no ability to ride over even the smallest bump and has extremely limited battery power.

Individuals who do need special seating may get coverage for a power wheelchair that has some capabilities outside the home. But only those with no capacity to "stand and pivot" from the wheelchair into bed can get coverage for a power wheelchair with the battery power and clearance capabilities many find essential to get around outside. This category of devices would be denied to many people living with multiple sclerosis, cerebral palsy, amyotrophic lateral sclerosis (Lou Gehrig's disease) and other debilitating diseases.

These coverage criteria are clinically unsound. There is no basis for using a "stand and pivot" test for determining coverage for a wheelchair that has added clearance. Worse, relegating scores of people with disabilities to "junk" wheelchairs and expressly denying them devices that would allow them to leave their homes is dangerous-many are bound to test the limits of these unsuitable wheelchairs.

CMS does have a legitimate interest in ensuring that Medicare only covers power wheelchairs that are medically necessary and in stamping out fraud. But this new policy is not the way to do it. The policy should be put on hold until CMS can develop clinically sound criteria. Please tell Health and Human Services Secretary Michael Leavitt to stop the local coverage determination from taking effect until the clinical aspects of this flawed policy are addressed. ( http://www.medicarerights.org/action/index.html)

For the longer term, Congress needs to prevent CMS from using its outdated legal interpretation to deny people with Medicare access to mobility devices that will give them the independence and quality of life that is their right. Please write to ask your senator to cosponsor S. 3677, bipartisan legislation that would eliminate the "in-the-home" restriction. ( http://www.medicarerights.org/takeaction.html)

Medical Record

"Developing political and legal standards are consistent with medical opinion: the costs of isolation for people with disabilities can include poorer health outcomes and higher systematic health costs. Also, scientific evidence indicates that people who get inappropriate mobility devices given their needs develop secondary medical conditions. In light of technological advances that today make appropriate equipment available and community integration possible, CMS has a responsibility to update its interpretation of the Medicare statute" ("Forcing Isolation: Medicare's 'In the Home' Coverage Standard for Wheelchairs ( http://www.medicarerights.org/
maincontentpolicybrief_03162004.html)," Medicare Rights Center, March 16, 2004).

"Medicare's new LCD [local coverage determination] will severely restrict access to appropriate devices for many of the 6 million beneficiaries with disabilities under the age of 65, as well as beneficiaries with disabilities over 65 years of age. These new coverage criteria are not based on functionality nor are they intended to meet the functional needs of beneficiaries. Rather, they are based on outdated standards that require individuals to be completely nonambulatory to receive an appropriate mobility device and will force many beneficiaries into inappropriate and low-functioning mobility devices" ("Medicare Issues New Rules for Power Mobility Device Benefit: From Bad to Worse," ITEM Coalition ( http://www.itemcoalition.org/), September 2006).

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