New Rehab group takes on Medicare

Monday, June 30, 2003

WASHINGTON - Frustrated by Medicare’s narrow definition of “in the home” and other antiquated policies for the disabled, a new coalition of rehab providers has formed to do battle against such restrictive statutory language.

The Independence Through Enhancement of Medicare and Medicaid (ITEM) coalition - now comprised of 65 consumer and provider groups such as the Paralyzed Veterans of America and the American Foundation for the Blind - wants CMS to relax restrictions that prevent reimbursement for DME used outside the home.

“Medicare should look more broadly at facilitating people’s ability to enjoy life in community and employment,” said Henry Claypool, a member of the coalition’s steering committee. “We need to make sure people are not getting trapped in their homes.”

While many believe that CMS is in a position to relax the restrictions and do more for people with compromised mobility, CMS disagrees, arguing that the statute itself - not CMS’s interpretation of the law - keeps Medicare from reaching more people.

“That is the law,” said one CMS official. “It is not an issue that we are afraid of utilization rising or not. We’re not trying to control utilization. We’re just trying to be consistent with the statute.”

That’s not the way Sharon Hildebrandt sees it. The executive director of executive director of AAHomecare’s Rehab and Assistive Technology Council (RATC) does not believe the law restricts CMS from relaxing the regulations on mobility devices.

“CMS could make these changes without even going to Congress,” she said. “They have the final say.”

Jim Greatorex, co-owner of Black Bear Medical in Portland, Maine, said many of his customers could benefit from a scooter or wheelchair but do not qualify under Medicare restrictions. The result? A lot of private purchases.

“If (a beneficiary) does not qualify, we have them sign a waiver of liability and a private cash sale is conducted,” Greatorex said. “Most DME rehab stores are open to private cash sales if the client is not covered under Medicare.”

More than 2.5 million Americans say they lack necessary assistive technology, and about 70% of them cite cost as a primary reason, according to coalition statistics.

“It’s very unlikely (CMS) will do anything about [the issue] unless a great deal of pressure is made about it,” Hillebrandt said. “It’s a battle ahead of us with all the budget problems.”