Prepayment Review Faces Mounting Criticism from Aging and Disability Communities
WASHINGTON, Dec. 22, 2011 /PRNewswire-USNewswire/ -- The American Association of People with Disabilities (AAPD) has asked the Obama Administration to stop a demonstration project that affects Medicare beneficiaries requiring mobility assistance, saying it "will have a significant, immediate and adverse impact on people with disabilities," reports the American Association for Homecare.
The Centers for Medicare and Medicaid Services (CMS) wants to require "prepayment review" for all power wheelchairs provided to Medicare patients in seven states – California, Florida, Illinois, Michigan, New York, North Carolina, and Texas – starting January 2, 2012. This will affect nearly half of all Medicare beneficiaries across the country who require power mobility.
Under the program, providers of home medical equipment and services will be forced to wait up to 16 months or more before being fully reimbursed after filling power wheelchair prescriptions for Medicare patients. These businesses are still reeling from a 13-month rental reimbursement policy mandated last January, which has caused many providers to leave the business. It has delayed the delivery of medical equipment that physicians have prescribed for seniors and people living with disabilities, especially in rural areas.
In a December 15th letter to CMS, Mark Perriello, AAPD's president and CEO, wrote that the project "jeopardizes care for almost every Medicare beneficiary" in the affected states.
"We respectfully request you take immediate action to stop this demonstration," Perriello wrote to Marilyn Tavenner, acting CMS administrator, "work with Congress and power mobility stakeholders, including consumers, to identify a viable alternative that will allow Medicare beneficiaries to receive the physician prescribed medical equipment they require while fulfilling CMS' mandate to reduce fraud, waste, and abuse within the power mobility device benefit."
AAPD joins the United Spinal Association and a growing list of consumer advocates that are strongly opposing the three-year, prepayment review demonstration project. In addition, last week a bipartisan group of 22 Members of Congress also wrote a letter asking CMS to halt the project.
In his letter, Perriello noted that AAPD has considerable clout in fighting on behalf of people living with disabilities, saying it is the nation's largest nonprofit cross-disability member organization and that it works with other disability organizations for the full implementation and enforcement of disability nondiscrimination laws, and other statues that impact people living with disabilities and their families.
Furthermore, Perriello cited the important role that mobility assistance plays in the lives of people with limited mobility, saying, "People with physical disabilities or chronic, debilitating medical conditions often need a power wheelchair to maintain their independence and participate in the life of the nation."
Under the CMS project, Perriello said, "Medicare beneficiaries bear the burden of uncertainty or denied their mobility independence as a result of it as a prepayment review occurs AFTER the physician-prescribed equipment is provided. In other words, the physician does an evaluation of their patient, writes a prescription for the medical care s/he deems appropriate, such as the provision of a power wheelchair, and the DME [durable medical equipment] supplier provides it."
Once the claim is submitted, Perriello said, "it is our understanding that CMS will then send a letter to the DME supplier asking for all of the documentation that supports the need for the device. They will then review the information and determine if payment should be made. Meanwhile beneficiaries, often living on limited fixed incomes, are placed in a position of paying their deductible and 20 percent copayment only to be at risk for having the device repossessed if the claim is denied. In addition, if the claim is denied for any reason the DME supplier will then have to pick up the chair from the beneficiary, if they are even able to provide it at all under these circumstances, and start the process over."
Perriello declared that "this does not constitute a demonstration; it effectively eliminates a Medicare benefit for individuals who reside in one of the States included in this program."
Across the country, advocates for aging and disability communities are voicing their concerns about the CMS program, and asking their Senators and Representatives in Congress to stop the project.
In California, Karen Miner, co-founder of two advocacy organizations, Research for Cure and Californians for Cures, said, "We are upset about the impact of this change on some of the most vulnerable people in our society. If providers go out of business or no longer serve Medicare patients, seniors and people with limited mobility must wait longer for the medical equipment prescribed by their physicians. This will cause pain and suffering. For someone with limited mobility, a power wheelchair can mean the difference between living independently in your home or confined to a care facility or nursing home."
In Michigan, Mike Zelley, president of The Disability Network, said, "This is a direct attack on some of the most vulnerable people in our society. Senior citizens and people living with disabilities need power wheelchairs to live independently in their homes and to delay confinement in expensive care facilities and nursing homes. Congress cannot allow CMS to restrict access to medical equipment that has been prescribed by physicians so that these Medicare beneficiaries can improve their mobility and enjoy a better life."
In New York, Angela Bray, an advocate for the disabled community and vice chair of the Human Rights Commission in Niagara Falls, said, "We urge Sen. Chuck Schumer to step in and help stop this project. Sen. Schumer has a long history of caring about vulnerable New Yorkers. It is unfair for the federal government to try and save money by making it more difficult for seniors and people living with disabilities to obtain power wheelchairs that can allow them to live independently in their homes, and delay confinement in expensive care facilities and nursing homes. This project must be stopped so that Medicare beneficiaries in New York can improve their mobility and their quality of life."
In addition, United Spinal Association wrote to Senators Max Baucus (D-Mont.) and Orrin Hatch (R-Utah), chairman and ranking member of the Senate Finance Committee, respectively, asking Congress to take immediate action to halt the project. The organization urged CMS to work with Congress and power mobility stakeholders to identify alternative approaches for reducing overpayments and abuse without significant disruptions to the disability and aging communities.
"Advocates across the country recognize that this is bad public policy that will harm some of the most vulnerable people in our society," said Tyler J. Wilson, president and CEO of the American Association for Homecare. "We hope that Congress and the Administration are hearing their voices. CMS moved unilaterally with no notice to Congress, Medicare beneficiaries, or the power mobility community. This policy must be stopped before our seniors and people living with disabilities are harmed by it."
The American Association for Homecare represents providers of durable medical equipment and services who meet the healthcare needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and mobility assistive technologies, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members provide homecare in all 50 states.
SOURCE American Association for Homecare