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DME Poses Problems for Medicare ProgramBy Rick Fitzgerald
In his April 2004 testimony before the Senate Committee on Finance, Jeremy Chwat, Director of Legislation for the United Spinal Association in Jackson Heights, N.Y., told those assembled about a press release issued by the Center of Medicare and Medicaid Services, (CMS) in September 9th, 2003, which states that Medicare payments for power wheelchairs had increased 450% since 1999. He then told the committee that, “While it is imperative to root out fraud and abuse in power wheelchair purchasing, it is equally important to ensure beneficiary access to power mobility.” With this short statement, he echoed the thoughts of everyone who depends on their wheelchairs to help them live independent lives and make positive contributions to their communities. According to Chwat, “More and more CMS demonstrates a willingness to compromise the rights and independence of individuals with disabilities in the name of fighting fraud and abuse.” He applauded the Department of Health and Human Services, (HHS) and CMS’s wish to deal with this growing problem. People with disabilities find themselves in his words, “Innocent bystanders in this battle.” On the same day CMS sent the press release, a joint release was issued by CMS and HHS announced their 10-point initiative, “Operation Wheeler Dealer.” The goal of this initiative is to curb fraud, waste and abuse in the Medicare program relative unscrupulous providers of power wheelchairs. In December 2003, CMS and its four national Durable Medical Equipment Carriers (DMERC’s) released a Medicare policy coverage clarification. Medicare would no longer cover or reimburse for manual or power wheelchair for people who could take more than one step even with the use of a cane, crutch or walker to get from bed to chair. Anyone able to do this was considered ambulatory under this clarification, so they were no longer eligible for a wheelchair. The following March, CMS rescinded this clarification. But fraud isn’t the only problem that Medicare has faced over the years. In a recent article written for Action Online, journal of the United Spinal Association, Alaine Perry told the story of Phyllis Johnson, (not her real name), a 77-year-old grandmother with several health challenges including heart disease and chronic leg pain. She cares for her granddaughter, whose mother works. Although she can move around in her home, Phyllis tires quickly, making walking any distance difficult. She asked Medicare to pay for a power wheelchair due to her lack of strength to operate a manual wheelchair outside. Current Medicare regulations allow her to get a manual chair only because she can use it inside her home. This regulation applies even if the person wants to do something outside the home, such as go to work, school, church or shop. This became a real problem for the family when her granddaughter started school last year. The closest bus stop to her home was three blocks away. Since that was too great a distance for both Phyllis and the little girl to travel alone, the school district agreed to drop her off one block away from the house. Unfortunately, this situation isn’t a new one. The Johnson story happens to many people. In fact, anyone who lives this way is caught up in Medicare’s “In The Home Rule.” This policy states that Medicare will pay for a wheelchair only for use in the home. This rule flies in the face of several governmental programs designed to assist people with disabilities find and maintain employment, thus helping them be more independent while contributing to the economy and taking a more active role in today’s society. These programs include the New Freedom Initiative, the Ticket to Work and Work Incentives Improvement Act and the Americans with Disabilities Act. Tina Fitzgerald is a service coordinator and benefits specialist for ARISE, an Independent Living Center in Syracuse, N.Y. Part of her job is to ensure that her consumers keep as much of their governmental benefits before, during and after they go to work. Her Cerebral Palsy keeps her in her power chair.“It is very frustrating for people with disabilities to be offered the opportunity to work and become self-sufficient while being denied the necessary equipment to leave their homes,” she said. The topic of difficulties with DME and the Medicare system is a complex one. Much more can and will be said about this important issue. Keep reading Independence Today for more details. ****************************** Rick Fitzgerald is a contributing writer for Independence Today. He has also worked for The Catholic Sun and the Eagle Newspaper Group in Central |
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Getting ready for
work or school is easy for most of us, but if you’re a person with a
disability, it can be a struggle if you don’t have the kind of equipment
to help you. Many members of the disabled community depend on durable medical
equipment, (DME) to assist them in their daily routine. Without the proper
lift, shower chair, bench or wheelchair, it would be impossible for many people
to lead much of a life. But for the past several years, a lot of the DME paid
for by Medicare and Medicaid won’t fit their basic needs.