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This landed in my email box with a note to fwd widely, and this does have some real implications to the wider disability community - including folks who do not qualify for medicaid or Medicaret. As indicated below - Many private insurance companies use the Medicare funding numbers to set their own reimbursement rates. Some states (I am not exactly sure of the status in Maine) are changing the requirement for wheelchair lifespans (The normal time that a wheelchair should last from 5 to 7 years,) and that change will very likely also be a change to private insurance. People are already using hand me down chairs or technology to get mobility issues covered. While the wheelchair model isnt really scalable to other forms of DME due to the funding structure of repairs and the way that's figured into the retail cost of the a wheelchair, it's an unsettling proposition.
So if the rising cost of gas isn't an headache enough, one more thing to worry about.
MJR
POWER WHEELCHAIRS – A REALITY CHECK:
Okay, so what’s the reality concerning your next power wheelchair? What
changes has CMS made this past year and a half? It all began November 15,
2006, but really started Jan 2007, when all power wheelchair payments made
by Medicare were reduced by 27%.
Now starting July 1, 2008 the same power chairs will be reduced again by
19%. This additional payment cut by CMS is from Medicare’s National
Competitive Bidding (NCB) program.
NOW TO THE REALITY CHECK:
If a consumer received a chair back before these dates a supplier would have been paid, let's say $8,000.00 for example. For a consumer to be given that same chair today the dealer will receive $5,840.00. Okay now, after July 1st because complex rehab was competitively bid - the amount will go down to $4,730.40.
So the BIG question is ... Will a consumer get the same quality chair as your last one? Well...when you look at the cold hard economics ....it is impossible to imagine. Most likely you will be provided with a chair of lesser quality and fewer features because of the dramatically reduced payments. How can a supplier purchase, service and provide to a consumer the same quality chair and features as before with these dramatic reimbursement reductions. Consumers will get a wheelchair but it will not be comparable.
While Medicare went into competitive bidding saying that consumers would receive the same quality products and services, it's not possible. With 2 serious power wheelchair reimbursement cuts since January 2007 amounting to over $3250.00 on a basic $8000.00 chair it’s not likely.
THE DOMINO EFFECT: So who does this affect? Just Medicare, right? NO
...WRONG!
PRIVATE INSURANCE:
It's important to know ....all other insurers mostly base their payments off of the amount that Medicare pays. Which means the dealer will be receiving less that the $4,730.40 from even private insurance companies. Again, consumers will receive products that will not be of the same quality and features as they received previously from Medicare or Private Insurance.
NOW WHAT ABOUT DUAL Medicare and Medicaid?
Are they hurt by this program? YOU BET!
Medicaid is different in each and every state, however; few if any pay the Medicare price and in most cases they can not pay more than the amount that Medicare pays. SO.... Read below where the head of Medicaid policy in Ohio says they will set their payment at about 20 to 25% below the Medicare rate!!!! Now the dealer will receive for the $8,000.00 chair of a year and a half ago a grand total of $3,547.80 as full payment for the item.
Remember the "DUAL " Medi-Medi can not pay nor can the dealer collect money
from that person and must accept this amount as payment in FULL!
Under the Medicare program a consumer (NOT A MEDI-MEDI) can choose to do an upgrade and pay for "deluxe" features and options€.
So what this wonderful program has done is to "Cost Shift" to the consumer for payment if they want to receive the exact chair they have today or, they must accept a much lesser chair.
CONCLUSION:
Wheelchair technology advancements over the past 2 decades have made incredible leaps offering consumers amazing functional features and options allowing them to live a more independent, productive lifestyle. Medicare provides consumers only the features and options that are medically necessary for them “In The Homeâ€. With the 2 new reduced complex rehab payment rates consumers will receive inferior equipment and decreased services than previous wheelchairs. We are at a serious turning point for
the worse. This is criminal. Equally bad is that other third party insurers base their payment off of Medicare. Is it time for you to voice your concern????
NEXT STEPS: What can you do?
(edited as some events have passed)
Support HR 2231, http://www.govtrack.us/congress/bill.xpd?bill=h110-2231
