Friday, August 23, 2013

Proposed Changes to Medicare & Medicaid Impact AAC & Power Wheelchair Access

Centers for Medicare and Medicaid Services (CMS)  have proposed changes to the coverage of Augmentative & Alternative Communication Devices which include altering how power wheelchairs are accessed and paid for. For AAC devices, the proposals move them to the capped rental category. Access to language and communication as well as independent or semi-independent mobility is an essential life activity. These changes will push back all of the progress which has been made in this area to improve coverage. All of these changes put significant barriers up for the acquisition of equipment which allows for increased participation across all life activities many people take for granted. These changes target some of the most vulnerable people around us.  

The ALS Foundation points out the following:

"Currently, most all SGD's and wheelchair accessories used by people with ALS are purchased by patients, with Medicare covering 80% of the costs.  Under a capped rental system, patients are required to rent these items over a 13 month period, after which time the patient owns the equipment. Medicare pays 80% of the rental fee each month.  If the patient passes away or no longer needs the equipment at any time during the rental period, the equipment is returned to the supplier.   The ALS Association's concerns include:

  • Access:  If a patient is institutionalized (extended hospital stay, hospice, nursing home) during the 13 month rental period, Medicare coverage for this equipment will cease.  Potentially, this means that a supplier of an SGD or wheelchair accessory can require that the equipment be returned, leaving patients without access to needed equipment.  By contrast, under the current system patients may keep this equipment when they are institutionalized as long as they own the equipment.

  • Cost: If a patient rents an SGD or wheelchair accessory for the full 13 month period, they will pay 5% more out of pocket than if they purchased the equipment up front. 

Quality:  Both SGDs and power wheelchairs are highly customized in order to meet the specific medical needs of individual people with ALS. When they are returned to a supplier, they cannot simply be supplied to the next patient.  They must be readjusted and customized to fit the needs of the next patient.  Therefore, under capped rental, suppliers do not have the same incentives to work with people with ALS or to fully customize these devices knowing that they may be returned to them."

Please take the time to comment and advocate, to prevent these changes from taking place. The comment period ends on August 30th. Here is a link to the commenting form: Regulation Changes .

You can also mail your comments to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1526-P, P.O. Box 8010, Baltimore, MD 21244-8010.



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