SENIOR JOURNAL.COM - Senior Citizens Information and News

Front Page    Search     Contact Us     Advertise in Senior Journal

E-mail this page to a friend!

Battle Heats Up Over Scooters, Power Wheelchairs for Elderly

Medicare says there are too many, advocates say Medicare too restrictive

Oct. 25, 2004 – News stories about the elderly people in Paintsville, Ky., over-running the streets in Medicare-supplied motorized scooters, peaked last week in a feature on the NBC Today Show. The manufactures and distributors of these devices say they are puzzled by the Paintsville story, because the real story is the restrictions by Medicare on this popular mobility equipment.

A coalition of manufacturers and providers for the equipment says the number of motorized wheelchairs approved by Medicare was cut in half in the twelve months proceeding February of 2004. And, they say, this trend has continued.

"For several weeks, the news media has focused attention on Paintsville, where articles and newscasts are reporting that the small town has been 'overrun' with elderly people on motorized scooters,” says RAMP, the Restore Access to Mobility Partnership, the coalition of power wheelchair providers and manufacturers.  

“The stories (about Paintsville) maintain that this has created 'traffic jams' and local government has struggled with how to deal with the problem. Some newscasts and articles -- most recently the NBC Today Show on Oct. 22 -- have mistakenly implied that Medicare is the cause of the problem,” says the news release from RAMP.

“We don't know why there may be a disproportionate number of scooters in Paintsville, but we do know that across the country senior citizens and Americans with disabilities are experiencing a far different problem: Medicare benefits for power wheelchairs and scooters are being restricted, and patients, their doctors and advocates for disabled citizens are outraged that Medicare is refusing to pay for this equipment,” continues the RAMP statement.

 In September of last year, Medicare announced a 10-point initiative to substantially curb what they called, “abuse of the Medicare program by unscrupulous providers of power wheelchairs and other power mobility products who prey on Medicare beneficiaries.”

At the same time the Department of Health and Human Services Office of Inspector General said it was investigating the proliferation of durable medical equipment fraud cases involving inflated billings to Medicare, charges for equipment and supplies not delivered, and the falsification of documents to qualify beneficiaries for wheelchairs and other equipment that they often did not need.

"Spending on power wheelchairs has increased nearly 450 percent over the last 4 years, an unprecedented growth in this benefit," said then CMS Administrator Tom Scully. "While many of these wheelchairs are provided by ethical suppliers and go to beneficiaries in need, we know that a great number of unscrupulous suppliers are promising free wheelchairs to beneficiaries who don’t need them. We are taking immediate action to stop these scams."

The number of Medicare beneficiaries with at least one claim for a motorized wheelchair rose from just over 55,000 in 1999 to almost 159,000 in 2002, an increase of 189 percent, while the overall Medicare population rose only 1 percent per year during that same time period, according to Medicare.

"This abuse is an insult to all Americans who pay taxes. It’s got to stop," Scully said. "Our 10-point campaign is an aggressive way to end this exploitation of the Medicare program."

The 10 points include:

1. To prevent fraudulent suppliers from enrolling with Medicare for the sole purpose of receiving inappropriate payments, CMS will immediately begin aggressively scrutinizing all new applications for supplier numbers. Because of this increased scrutiny, we do not anticipate issuing any new supplier numbers until early 2004.

2. CMS will publish regulations that will enhance the ability to screen new supplier applications to identify and prevent inappropriate enrollment of suppliers by providing a more detailed screening process, allowing CMS the time needed to properly review applications, and providing sanctions against suppliers abusing the enrollment process.

3. To address the rampant fraud and abuse in the Harris County, Texas area, effective immediately, all payments for motorized wheelchairs will be personally and individually approved by CMS staff on a special task force based in the Dallas Regional Office.

4. So that CMS can be sure that all wheelchair providers in Harris County know and understand Medicare coverage rules, CMS will require all wheelchair suppliers to attend mandatory training overseen by the Dallas Regional Office on wheelchair coverage and medical review policies.

5. To quickly identify and punish fraudulent suppliers, CMS, Durable Medical Equipment Regional Carriers (DMERCs), and law enforcement agencies will collaborate to process fraud cases and assure aggressive, timely application of sanctions, and civil or criminal prosecutions. CMS will exercise one of its strongest administrative tools, payment suspensions, to stop the improper hemorrhaging of Medicare dollars.

6. CMS will finalize regulations revising coverage policy for motorized wheelchairs and scooters to assure that national policy accurately defines the conditions under which Medicare will cover mobility products. This policy will require, for the first time, that the medical provider see the patient before prescribing a wheelchair or scooter. However, the medical provider may prescribe either a motorized wheelchair or a power-operated vehicle. Under existing policy, only a specialist may prescribe a POV.

7. DMERCs will immediately adopt Local Medical Review Policies (LMRP) that accurately portray the clinical conditions for which mobility products are reasonable and necessary. This will educate suppliers and beneficiaries on when wheelchairs will be paid for by Medicare and will facilitate correct billing and payment for mobility products.

8. Additionally, the DMERCs will adopt a consistent approach to medical review so that when national billing and utilization trends are identified, Medicare knows that only claims that are reasonable and necessary are paid and that national billing problems are resolved in a consistent manner.

9. So that Medicare can be assured that it is paying appropriately for motorized wheelchairs, CMS will develop inherent reasonableness review guidelines. Motorized wheelchairs will be the first item analyzed for potential inherent reasonableness adjustments.

10. To put physicians and beneficiaries back in charge of their mobility equipment decisions, CMS will work with physicians to clarify their prescribing responsibilities, and beneficiaries, explaining their role and Medicare coverage criteria.

In April, 2004, the new Centers for Medicare & Medicaid Services Administrator, Dr. Mark D. McClellan, announced a series of further steps on Medicare coverage and payment policies that apply to power wheelchairs and power scooters “building on recent successes in reducing Medicare abuse.”  He said CMS was implementing a three-pronged approach focused on coverage, payment and quality of suppliers of power wheelchairs.

“Medicare spending for power wheelchairs and power scooters has skyrocketed in recent years to more than $1.2 billion a year, yet some beneficiaries who really need these mobility devices are not getting high-quality and timely assistance,” said Dr. McClellan.

His three part plan included:

1. A plan is to develop guidance on the current coverage of power wheelchairs. CMS’s chief medical officer was to bring together clinicians from across HHS and other government agencies to refine and describe the conditions that are associated with the current coverage definition and to develop draft guidance for determining whether a patient meets the definition of “bed or chair confined.” The goal was to focus on a set of clinical and functional characteristics that are evidenced-based and will better predict who would benefit from a power wheelchair or scooter. This regulation, he said, “will, in part, implement provisions of the 2003 Medicare Modernization Act.”

2. The second area in which CMS is taking action is in billing and payment for power wheelchairs and scooters.  CMS’ goal is to assure that Medicare pays appropriately for motorized wheelchairs, and that beneficiaries have access to them when needed.  The technology, range of products, and market for power wheelchairs have changed substantially since the current HCPCS codes for power wheelchairs were added in late 1993. Currently, most power wheelchairs are billed under a single code (K0011), for which Medicare has set a single ceiling amount of $5,296.50, even though different models of these wheelchairs have substantially different market prices.  CMS is working with a national coding panel to develop a new set of codes that better describe the wheelchairs currently on the market.  Accurate individual payment ceilings would then be developed for each of the new codes. CMS also planned to implement competitive bidding for a number of items of durable medical equipment, as authorized by last year’s Medicare modernization law.  CMS expects to include power mobility devices in the competitive bidding program.

3. The third prong of the plan wass to ensure that there are strong quality controls for suppliers to assure that beneficiaries will receive high-quality power mobility services.  CMS will revise the supplier standards for enrolling in Medicare to include quality measures as required by the MMA, building on existing standards by the industry.  CMS will develop a proposal for an accreditation program, as part of the implementation of competitive bidding, to further ensure that power wheelchair suppliers meet industry and community standards for power wheelchair utilization.  Lastly, CMS, through its contractor, the National Supplier Clearinghouse, will continue its work to ensure thorough review of all applications for enrollment so that only qualified suppliers are allowed to bill the Medicare program.

RAMP, however, feels there is still a crisis with Medicare coverage. "Stories about 'Paintsville scooters' belie the real crisis going on with Medicare coverage of mobility equipment,” they said.

“There is a clear difference between a power wheelchair, which is needed by people with disabilities to perform daily functions in their home, and a power operated vehicle, or scooter, RAMP declares. “The primary Medicare category for power wheelchairs is 'K0011.' All products reimbursed for this benefit category are power wheelchairs, not scooters. Data from the Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare system, demonstrate the decline in power wheelchair coverage: in Feb. 2003, 24,000 claims for power wheelchairs were approved; a year later the number of approved K0011 claims in Feb. 2004 had dropped to 12,000. The downward trend in approved claims has continued throughout 2004. That's the real story. By contrast, scooters are largely paid for by the users and are not reimbursed through Medicare. Scooters are designed to increase the mobility of users who may have some limitations, such as age or their health.”

"Our concern is that while Paintsville is getting the headlines, people across the country are being denied the mobility equipment they need to improve their mobility. We urge the news media to cover the real story, the one that is impacting senior citizens and Americans with disabilities in cities and towns across the nation. There are many more seniors and citizens with disabilities in need of power wheelchairs and scooters, than there are towns like Paintsville," concluded the statement by the coalition.

Restore Access to Mobility Partnership (RAMP) is a coalition representing power wheelchair providers and manufacturers. Members include: the American Association for Homecare; Invacare Corporation; the MED Group; Mobility Products Unlimited, LLC; Pride Mobility; and Sunrise Medical.

Copyright: SeniorJournal.com