Senior citizens and people living with physical disabilities in New York will have limited access to power wheelchairs if the Administration enacts a restrictive prepayment review process for beneficiaries seeking mobility assistance through the Medicare system, according to consumer advocates and home medical equipment providers in the state.

The Centers for Medicare and Medicaid Services (CMS) has listed New York and six other states as locations where it wants to establish a prepayment review demonstration project for all Medicare beneficiaries with prescriptions for power wheelchairs. The ill-conceived project would result in many providers waiting up to 16 months or more to be fully reimbursed by the government. Many providers would go out of business, causing significant delays in filling prescriptions and providing power wheelchairs to people in dire need of mobility assistance.

Citing the impact on some of the most vulnerable people in American society, consumer advocates and home medical equipment providers are calling on Congress to stop the demonstration project that is slated to be implemented in just a few weeks, on January 1, 2012.

"We urge Sen. Chuck Schumer to step in and help stop this project," said Angela Bray, an advocate for the disabled community and vice chair of the Human Rights Commission in Niagara Falls, NY. "Sen. Schumer has a long history of caring about vulnerable New Yorkers. It is unfair for the federal government to try and save money by making it more difficult for seniors and people living with disabilities to obtain power wheelchairs that can allow them to live independently in their homes, and delay confinement in expensive care facilities and nursing homes. This project must be stopped so that Medicare beneficiaries in New York can improve their mobility and their quality of life."

In 2009, 6,793 New Yorkers received mobility assistance through Medicare and there are about 418 providers in the state.

"Mobility assistance is so important to the people who need it," said Gracie Chambers, who does public policy outreach for Independent Living of Niagara County, NY. "We can't stand by and let CMS restrict mobility for our friends, parents, grandparents and other relatives who depend on Medicare. Congress must act."

Todd Vaarwerk, director for advocacy and public policy for the Western New York Independent Living, Inc, said that the demonstration project "would result in vulnerable people all over New York being confined to their beds and chairs because they cannot get power wheelchairs. That would be cruel and uncaring. Medicare is supposed to provide hope, not take it away."

Yesterday, a group of 22 bipartisan House Members wrote to CMS asking the agency to stop the prepayment review project.

"…we have many concerns with enacting a demonstration project of this size with minimal notice to the affected stakeholders," the lawmakers wrote. "Such a project could result in significant job losses and jeopardize seniors' access to this important Medicare benefit… We encourage you to halt the prepay review demonstration project due to the potential threats to businesses, jobs and seniors' access to care."
Among the signees of the letter were New York Congressmen Rep. Edolphus Towns (D), Rep. Peter King (R), Rep. Brian Higgins (D) and Rep. Charles Rangel (D).

National consumer organizations are also concerned about the Medicare beneficiaries impacted in New York, as well as California, Florida, Illinois, Texas, Michigan and North Carolina.

In a letter to Sen. Max Baucus (D-MT) and Sen. Orrin Hatch (R-UT), the chairman and ranking member of the Senate Finance Committee, the United Spinal Association asked Congress to take immediate action to halt this demonstration before the congressional recess. The organization urged CMS to work with Congress and power mobility stakeholders to identify alternative approaches for reducing overpayment and fraud and abuse without significant disruptions to the disability and aging communities.

Furthermore, because the prepayment reviews will occur after the power wheelchairs have been delivered to beneficiaries, the Association raised the possibility that providers might be forced to "rescind care" or take back equipment if claims are denied.

"With a considerable percentage of the currently high error rates reported on these claims being attributable to paperwork inaccuracies or omissions, suppliers are placed in the position of potentially having to remove denied mobility devices from beneficiaries' homes when the medical necessity may be genuine," the United Spinal Association wrote in its December 8th letter.

The letter goes on to state, "Beneficiaries should not be burdened with the uncertainty of the pre-payment review phase or denied their mobility independence while CMS develops and implements their own, untested, prior authorization process. Nor should beneficiaries, often living on limited fixed incomes, be placed in a position of paying their deductible and 20 percent copayment only to be at risk for having the device repossessed if the claim is denied for any reason."

Meanwhile, providers in New York are considering whether they can even continue operating under these circumstances.

A year ago, CMS implemented a 13-month rental reimbursement policy for mobility equipment that spread reimbursement for power wheelchairs over a 13 month period for providers. Already, many providers across the country have gone out of business. In fact, utilization of the Medicare power mobility benefit dropped more than 25% from a year ago largely because of this mandatory rental policy. Now, the prepayment process would add an additional three months or more to when the rental payments would even begin.

"We cannot sustain our businesses under this process," said Bill Tobia, RPh, Managing Member of Home Medical Equipment, LLC in Garden City, NY. "How can we pay a manufacturer for the power wheelchair, incur costs fitting the patients, handle the extensive paperwork and deliver the equipment without getting fully reimbursed for 16 months. This is crazy! What other industry is asked to deliver services and products and not get paid for such a long period? These policies are driving providers out of business. When the government succeeds in eliminating providers, there won't be anywhere for Medicare patients to get mobility assistance."

The American Association for Homecare represents providers of durable medical equipment and services who meet the healthcare needs of millions of Americans who require oxygen equipment and therapy, wheelchairs and mobility assistive technologies, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members provide homecare in all 50 states.