Medicare Wheelchair Benefit Partially Restored

MDA Advocates help sway legislators drafting health care reform bill

by Quest Staff on July 15, 2009 - 3:30pm

Proposed legislation that would have eliminated a first-month purchase option for power wheelchairs provided by Medicare now has been reworked to retain this option for those who use complex Class 3 power wheelchairs.

MDA Vice President for Advocacy Annie Kennedy credited quick response by MDA advocates with helping sway the House of Representatives Tri-Committee on health care reform, which crafted the Americans Affordable Health Choices Act (H.R. 3200), a proposed package of health care reforms. She noted that most of the people served by MDA use Group 3 power wheelchairs.

“Of course, the ideal would be for all power wheelchairs to be available as a first-month purchase option,” said Kennedy. “But we are pleased to report that this language addresses the majority of the concerns that were of the most significance to our community.”

First-month purchase is preferable

Under current regulations, people who obtain a power wheelchair through Medicare have the option of buying it any time during the first month after it has been prescribed for them. If they exercise this option, Medicare pays the vendor outright for the chair.

If a beneficiary doesn’t buy during the first month, then Medicare rents the chair for the beneficiary for 13 months, after which the beneficiary automatically owns it.

More than 90 percent of Medicare beneficiaries choose the first-month purchase option because their chairs are highly customized for their unique needs, and they don’t want to risk losing them if they enter the hospital or other professional care facility during the 13-month rental period.

Medicare wheelchair prescriptions are temporarily discontinued when beneficiaries are in such a facility, and the vendor is free to rent the chairs to someone else.

Because vendors have a large, upfront financial investment in the chairs, they also prefer the first-month purchase option. If they have to wait 13 months before the chair is fully purchased from them, vendors may limit their investment by offering fewer custom options – an obvious problem for users requiring complex chairs.

Wheelchair classifications

Group 3 wheelchairs are prescribed for people unable to stand and pivot to transfer from one location to another due to a neurological condition or myopathy.

This is the same class of mobility equipment that was included as an exemption in the Medicare Improvement to Patients and Providers Act (MIPPA) last fall.

The proposed health care reform legislation still eliminates the first-month purchase option for those using Group 1 and Group 2 power wheelchairs.

MDA advocates Take 5

In late June, MDA’s Take 5 advocacy program alerted its network of advocates about the elimination of the first-month purchase option and urged them to contact their legislators about the negative effects of the legislation.

“The result was an incredible outpouring of support from our MDA community as well as a number of patient advocacy organizations,” said Kennedy. “Together we accomplished this critical change in the proposed legislation.”

While the modified proposal is “good news for our community,” Kennedy said, it’s far from being complete. MDA’s Advocacy program will continue to issue updates and alerts as the health care reform package evolves.

Interested consumers can sign up for advocacy alerts and learn how to “Take 5” – five minutes -- to reach out to their local representatives by using MDA’s online advocacy tools at www.mda.org/advocacy.

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