Wheelchair Diffusion blog

CMS (Medicare) is moving forward with a national competitive bidding program for complex and rehab power wheelchairs, seating and positioning systems, and supporting items. Medicare plans to purchase these items through a low bid process.

“These items are completely inappropriate for competitive bidding based on the complexity of the medical and functional needs of the individuals that use these products and the customized manner in which they are provided. These are not “one-size-fits-all” products. Including complex rehab equipment in the competitive bidding program will prevent Medicare beneficiaries from obtaining the appropriate technology necessary to meet their functional and medical needs.”

You can read the details and take action at:
http://capwiz.com/medgroup/issues/alert/?alertid=9830301

More bad news for wheelchair users. This time Utahns who depend on Medicaid for their wheelchair funding are taking the hit. This appeared in the Salt Lake Tribune.

“Wheelchairs designed for use outside the home will no longer be covered by Medicaid under a rule change that disabled-rights advocates say is misguided, and one occupational therapist likened to placing hundreds of Utahns on house arrest.

Utah health officials say the rule simply codifies existing practice. For more than a decade, Medicaid has paid only for manual and motorized wheelchairs deemed medically necessary and designed for use in the home, said Medicaid budget supervisor Don Hawley.

“Just because the design is for the home doesn’t mean it won’t be suitable for outside,” said Hawley. “But we’re not going to pay for someone to have nobby sports tires.”

Advocates fear, however, the rule will be taken too literally by front-line claims workers and used to deny benefits.”

I’m having a great deal of trouble with Hawley’s concept of a wheelchair is a wheelchair is a… I’m also having a problem with Don’s wisecrack sarcasm regarding not paying for “sports tires”. Hey Don, I’m sure that there are thousands of wheelers in Utah who thought that you were going to buy them sports tires. The requests are probably rolling in by the bag full and bringing your operation to a complete halt each and every day.

Here’s what I really think. I think that Mr. Hawley knows little about wheelchairs and even less about how important and necessary the right wheelchair is to a user. I also think that tossing about statements that have no relevance to the real world situation is nothing but cheap soapboxing and misinformation mongering. Yes, much of the general public may in fact agree with Mr. Hawley, but they probably have few insights by which to judge these matters.

Mr. Hawley on the other hand should have the insights and the knowledge to state his case with the relevance and sound logic that this serious matter deserves. Rather, he chose to convince the public by use of flawed homegrown logic on wheelchairs and a wallet launched wisecrack.

Doubt it not, many wheelchair using Utahns will be imprisoned within their homes because of this. The resultant cost of in-home services and the cost of increased medical expenditures for these people will far exceed the cost of an appropriate wheelchair, with or without “nobby sports tires”.

Hawley is not the only gatekeeper out there spewing this stuff. There are lots more in every state and at the national level. What I’m not hearing from them is the bottom line. In the event that people do loose their independence and mobility or are rendered “housebound” (such an ugly word), what then? Can the victims and their families go to their designated Hawley and say- “Hey, something went wrong. You said this wouldn’t happen. How about helping us out.” I’ll bet you a set of “nobby sports tires” that they won’t even make it through his door.

For most of us Utah is a far away place. Many of you may be thinking that this won’t or can’t happen in my corner of the world. Well, it already has, and there’s no safe haven. Medicare, a NATIONAL program, has been rolling out their “In the home” machine for several years now and they have some killer refinements on it yet to come.

If you think confining and restricting people is acceptable then you probably wasted your time reading down this far. If you think that things need to change then it may be time for you to kick in and help with the changing.

Take action on this issue and join a cause. If you don’t like structured causes then make some noise on your own. This isn’t a hard one to win. Similar to Mr. Hawley’s dollar based logic, it’s all in the numbers.

A number of organizations have for some time been hot to change Medicare standards that keep people from getting the wheelchairs that they need. Insiders and advocates have come to call this restriction the In The Home (ITH) restriction.

The members of the Item Coalition have for some time now been rallying the troops in opposition to this Machiavellian madness. Here is the latest good news from the Item Coalition.

ITEM COALITION APPLAUDS INTRODUCTION OF LEGISLATION TO REMOVE MEDICARE’S “IN THE HOME” RESTRICTION

[Washington, D.C.] Today, the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition lauds the introduction of important bipartisan legislation by Congressmen Langevin (D-RI) and Ramstad (R-MN) to modify Medicare’s “in the home” restriction on mobility devices.

“This legislation will help ensure that individuals with disabilities have access to appropriate mobility devices and, in turn, improved access to their communities,” said Congressman Jim Langevin, Co-Chair of the Bipartisan Disabilities Caucus. “It is time we remove this outdated restriction and better align Medicare policies with the disability community’s goal of independent living.”

The Medicare Independent Living Act (H.R. 1809) would significantly improve community access for Medicare beneficiaries with mobility impairments by removing a discriminatory restriction that bases the coverage of mobility devices solely on an individual’s mobility needs inside their home.

“It is long overdue for Congress to repeal Medicare’s ‘in the home’ restriction on mobility devices and give people living with disabilities the dignity and freedom of independent living,” stated Congressman Ramstad, also a Co-Chair of the Bipartisan Disabilities Caucus.

The statutory “in the home” language was originally meant to define durable medical equipment (DME) as devices that were provided outside of a hospital or skilled nursing facility and, therefore, warranted separate reimbursement under Medicare Part B, rather than Part A. However, over time, Medicare has chosen to interpret this language in a way that restricts coverage of mobility devices to only those that are reasonable and necessary in the individual’s home.

“Perpetuation of the ‘in the home’ restriction contradicts numerous other government initiatives such as the Americans with Disabilities Act, the Olmstead Supreme Court decision, the Ticket-to-Work Program and the New Freedom Initiative – all aimed at improved community access for individuals with disabilities,” stated Lee Page with the Paralyzed Veterans of America and a member of the ITEM Coalition Steering Committee. “An individual’s need for mobility does not end at their front door, but rather extends to places such as work, school, and the community in general.”

“This legislation is vitally important to individuals with mobility impairments because it will help connect the goal of independent living with the tools necessary to achieve this goal.” stated Paul Precht of the Medicare Rights Center and member of the ITEM Coalition Steering Committee. “We look forward to working with the bill’s sponsors to ensure its passage at the earliest opportunity.”

The ITEM Coalition was formed in 2003, and its 74 member organizations include a diverse set of disability groups, aging organizations, consumer groups, labor organizations, voluntary health associations, and non-profit provider associations. The ITEM Coalition’s purpose is to raise awareness and build support for policies that improve coverage of assistive devices, technologies and related services for people with disabilities of all ages. For more information on the ITEM Coalition, please visit www.itemcoalition.org.

I am truly amazed that people have not had enough of this wheelchair issue that has been going on for a number of years now. Think about it? Being tied to a ball and chain of a wheelchair for five long years. Even when everyone from your doctor and therapist to your manicurist know it is the wrong chair, or just an unreliable piece of crap, or both. Why would anyone or any group of people inflict this on others? Why would the rest of us sit by and allow this affliction to be perpetuated?

Everyone has the right and should be given the opportunity to move around outside of their own four walls and to expand, to chase dreams, or to just be a part of the community. Keeping people jailed in their homes for lack of the right wheelchair or for lack of repairs is an abomination. The morality of this makes sense only to those Medicare practitioners of Machiavellian politics who assume that denying wheelchairs will save them countless dollars regardless of the suffering and regardless of the expense to other programs and people. Well, maybe old Machiavelli was right. Maybe the end does justify the means. Let’s muster the means and put an end to this.

We (United Spinal Association) are getting ready to go another political round with Medicare. We will be trying to get some legislative actions going that would remove the heinous “In the Home” rule that Medicare uses as their guide and built in disqualifier. We will be setting up an action center where people can sign up to receive emailed alerts containing information on how to support this effort. There will be a number of disability related organizations and coalitions joining us. What we need more than anything is groundswell, public consensus, word from the trenches. That’s what really works.

I will be posting details on how to sign up on these pages. Be a voice. Be an advocate. Who wants in?

Many of you may have already read my thoughts on Medicare (CMS) and how they deal with funding wheelchairs for their clients. Therefore, I’m going to skip over all of the standard prose on independence and mobility and get right down to it. People, Medicare is not the only alligator in the swamp. It’s a big swamp out there with lots of room and lots of money changing hands.

Okay, what’s snapping at me? It’s the emails and the telephone calls. It’s the horror stories and the lack of concern. It’s a good amount of guilt on my part for not moving on this issue. Aside from blogging and web mastering, I occasionally need to earn a living by being a professional advocate. My wife and kids seem to really appreciate this. Anyway, in doing so I do get calls, letters, emails, and submissions regarding problems that people are having with their wheelchairs, with Medicare, and with the wheelchair industry. In any given week, the complaints regarding wheelchair manufacturers and distributors way out number the Medicare complaints.

Most of the people are wheelchair users or their family members. They are most often desperate, confused, and in trouble. They are both physically and emotionally trapped because of a malfunctioning wheelchair, a misrepresented wheelchair that is not performing as claimed, a nightmare of a wheelchair that is wrong for them, dangerous, or worse, a wheelchair that is dead in the water.

Most of these people have jumped through hoops of fire to get a chair funded by whatever means necessary, and are then being told that they cannot get help in resolving a problem. Who is telling them this? The same people that made the wheelchair or scooter and the same people that sold it to them.

“The industry” is running scared at present. Medicare, their largest customer is up to tricks and of course the industry is concerned about loss of profits as a result. Very understandable. They are in business to make money. Therefore, if it takes money to make money they are cool with that. That’s the way of things. Much of the funding that is carrying the movement against the restrictive changes in Medicare’s power wheelchair policy is being forked over by big players in the industry, and we thank them for that. Much of the talk regarding Medicare’s impact on wheelchair users is being put forth by these same people and those that they fund. Now, that’s really what’s bugging me.

The obligation does not end with the funders such as Medicare, Medicaid, and the insurers supplying someone with a wheelchair. It extends much further and for much longer than that. It is the responsibility of the industry to support the product and user by honoring warranties, being forthcoming with information, not misrepresenting products, being timely with services and help, being responsive, and biting the dollar bullet in resolving legitimate problems when need be. At present, things are far from that. For many wheelchair users it is not just a case of “buyer beware”. It is a case of consumer be damned.

As an advocate, I am thinking that the two issues are just too closely related. We are busy fighting Medicare’s first line troops on these wheelchair policy issues while many people who got em can’t use em for lack of support. No, it can’t’ work that way. Get a wheelchair, use a wheelchair, and benefit from use of the wheelchair. That’s the way it works. It’s not about swamps after all. It’s about dominoes and interdependency and people’s lives. It’s an all or nothing deal.

I really need to rethink the issues and this entire turning a blind eye thing. That one is for my conscience. I do believe it is time to move on this issue. It just seems like the right thing to do.

Most of you probably don’t know what I’m talking about. That’s cool; you probably have to be an insider or a victim to get it. Maybe reading some of the first hand experiences will help people understand. Okay, just ask me and I will start posting them a few at a time. Step one toward a solution- A dose of reality. Anyone interested?

I don’t really want to say “I told you so”, but I will anyway. A recent audit by the GAO indicates that Medicare’s mechanism for controlling less than desirable medical equipment dealers may be nothing more than Swiss cheese. As I have said before, Medicare needs to look inward as well as outward for solutions to these fraud issues. They need to be as tough on themselves as they are trying to be on their clients and providers. While they have managed, at great expense (our money), to wrap themselves in a blanket of contractors, sub-contractors, and self righteous administrators, they have yet to experience any increased warmth. Swiss cheese makes for poor insulation and it smells really bad after a while.

It appears that the costly and complex anti-fraud monster that they have created is beyond their ability to manage. Similar to Doc Frankenstein’s dilema, the creature has taken on a life of its own and is out of control.

A recent reference on this issue from Henry J. Kaiser Family Foundation, and the official report from the United States Government Accountability Office.

As stated by The Honorable Charles E. Grassley, Chairman, Committee on Finance United States Senate, to whom the GAO report was issued-

“Complacency by the watchdogs hurts both taxpayers and beneficiaries. Money is wasted or lost to fraud, and quality of care can be jeopardized when products and services come from con artists rather than qualified suppliers.”

What do you call a disaster that has been compounded by yet another disaster? Does it escalate to a major disaster, or a catastrophe, or possibly a disaster of some quantifiable proportion? It beats me. One thing is for sure, hurricane Katrina was not the only disaster to hit wheelchair users in the Gulf area.

I had a chance to spend some time talking with wheelchair users while doing a relief gig in Baton Rouge. A number of these people required repairs to their wheelchairs due to Katrina or due to the lack of services and parts in Katrina’s aftermath. What was saddening, though not surprising, was that many of these people had needed wheelchair repairs or replacements long before Katrina ever showed up on the radar and still needed these services after Katrina moved off the radar.

From a mobility perspective, Katrina had served to compound the problems created by insensitive and lethargic funders such as Medicare and Medicaid who leave their clients to face daily life and events such as hurricane Katrina with inappropriate and poorly functioning mobility devices and wheelchairs. Katrina was a terrible act of nature that was beyond anyone’s control. The other disaster is a terrible recurring act by agencies and departments mandated to provide assistance. Which one is the greater disaster?