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We've all seen the partisan politics and televised tirades both for and against recently-passed Health Reform Bill PL111-148. However, no matter one's opinion on the legislation at large, when we really study its content one policy at a time from a non-partisan, unemotional perspective, what's crystal clear is that the legislation isn't inherently good or bad, but good and bad – and that includes the issues directly relating to those of us with disabilities and our mobility.

For example, Section 2401, the Community First Choice Option, entitles those with disabilities to greater in-home care services, moving many out of nursing homes:  

“The State shall make available home and community-based attendant services and supports to eligible individuals, as needed, to assist in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks through hands-on assistance, supervision, or cueing." (Effective October 1, 2010 in PL 111-148, and October 1, 2011 in HR 4872)

The Community First Choice Option is a win-win for everyone – beneficiaries can have a higher quality of life by living at home versus a care facility, and tax payers save money because in-home care is much more cost effective than institutional care.

Unfortunately, to the downside, the Health Reform Bill further jeopardizes access to mobility products for those in need, striking us on several fronts.

Elimination of the Standard Power Wheelchair First-Month Purchase Option
The Health Reform Bill eliminates the right for Medicare beneficiaries to have the financial decision to purchase a “standard” power wheelchair, effecting 94% of power wheelchair users who have chronic, long term disabilities and require a power wheelchair to remain active and independent in their homes and communities. (A “standard” power wheelchair, put simply, is one that doesn't have complex rehab capabilities, such as power seating, etc. If you have a power wheelchair with a captain's seat and basic features, you likely have a “standard” power wheelchair.)

Up until this point, the Medicare program has allowed beneficiaries of “standard” power wheelchairs to choose whether they want Medicare to purchase the power wheelchair prescribed by the physician or rent it (presuming a short-term need). Historically, 95% of beneficiaries chose to purchase their power wheelchair because of its permanent need and some form of tailoring, such as seat size, legrest style, and so on. However, as of January 1, 2011, Medicare will no longer purchase “standard” power wheelchairs, instead requiring a 13-month rental period, at which point re-assessment will determine if the power wheelchair is still needed, and if it is, it will be purchased. The consequences for consumer-beneficiaries are profound:

- The DME supplier will provide beneficiaries with “fleet” rental power wheelchairs, not one ordered for a beneficiary's exact specifications and needs.

- In many cases, the beneficiary will receive a used power wheelchair from the rental fleet.

- The DME supplier retains ownership for 13 months, and if still needed at that time, ownership of the power wheelchair is transferred to the beneficiary.

- If the beneficiary is admitted to a hospital during the 13-month rental period, coverage for the power wheelchair is revoked during the stay. (You literally will no longer have your power wheelchair while in the hospital. If you still need a power wheelchair upon discharge from the hospital, the supplier can deliver one back to you; however, there is no guarantee you will receive your same power wheelchair.)

Clearly, Medicare beneficiaries (and all who rely on insurance), should be horrified by the elimination of the Standard Power Wheelchair First Month Purchase Option as of January 1, 2011 – especially when we consider that, by policy, beneficiaries lose their wheelchairs upon a hospital stay, to name one totally unacceptable consequence.

Competitive Bidding Expansion Nationwide
The Health Reform Bill deals another blow to beneficiaries who rely on mobility products: Competitive Bidding expansion.

Competitive Bidding expansion divides the United States into 100 “Competitive Bidding Areas” (CBAs), and requires DME suppliers to place bids to be the exclusive product supplier for Medicare in a CBA, and the lowest bidder wins. For example, if X-Medical, Y-Medical, and Z-Medical are currently Medicare suppliers in Riverside, California, a beneficiary can purchase a wheelchair from any one, making an informed consumer decision. However, as of January 1, 2011, only one of the suppliers – say, Y-Medical – with the winning lowest bid will be allowed to serve Medicare beneficiaries. The result is that a beneficiary's choice of DME suppliers will be removed – and X- and Z-Medical will likely go out of business. For consumer-beneficiaries, the impacts are obvious:

- No longer able to choose among providers, creating a captive market.

- Requirement to switch from current supplier to winning-bid supplier.

- A risk of poor service and slow delivery, with virtually no recourse toward a bad supplier who holds the exclusive contract.

- The elimination of at-home repair services.

The first 9 CBAs go into effect January 1, 2011, beginning with the following areas:

Charlotte, NC (parts of SC)
Miami, FL
Cincinnati, OH
Orlando, FL
Cleveland, OH
Pittsburgh, PA
Dallas, TX
Riverside, CA
Kansas City, MO (parts of KS)

From these areas, Competitive Bidding will cover the United States, area by area, to the tune of 100 CBAs by 2016.

2.3% Tax on Power Wheelchairs Manufactured
Indirectly effecting consumers, and of consequence to the mobility and home medical equipment industry as a whole, manufactures of power wheelchairs will have to pay a 2.3% sales tax on all power wheelchairs sold, effective January 1, 2013. This tax directly adds 2.3%  to the cost of manufacturing a power wheelchair, and while it may not seem like a large additional cost, it literally adds to the 39.78% cut in power wheelchair funding during the past 5 years, where manufacturers have to once again absorb a pricing impact. Fortunately, manufacturers have time to strategically absorb the tax, but a real concern is that it will cost jobs, as well as possibly require removing features from products.

Vital Consumer Action Items
Although signed into legislation, both the elimination of the Standard Power Wheelchair First Month Purchase Option and Competitive Bidding remain policies of great debate – and it's vital to get them repealed.

As a consumer who supports preserving the First Month Purchase Option for standard power wheelchairs, you should contact the Health Legislative Assistant for your Senators and Representative at 202-224-3121 or on-line via Capitol Connection.   Ask them to support the budget neutral alternative developed by the Senate Finance Committee to preserve the first month purchase option for standard power wheelchairs via a series of phased in payment reductions. Restoring the policy of allowing you to purchase the equipment in the first month will ensure appropriate access to equipment and lower costs to you and the Medicare program.

To repeal Competitive Bidding, please contact your Representative directly, and ask him or her to co-sponsor HR 3790. HR 3790 repeals Competitive Bidding - it's vital that you get your elected Representative to co-sponsor HR 3790.

Take Action
When it comes to the Health Reform Bill's passage, it's easy to assume that what's going to happen is going to happen. However, you don't have to let it happen to you. When we look at the Bill's Sections that directly impact us as those who rely on mobility products, it becomes clear that this isn't about partisan politics, but about people. Again, contact your Representative and Senators today, and demand that they repeal  the elimination of the Standard Power Wheelchair First Month Purchase Option and Competitive Bidding – that is, don't let these destructive disability policies happen to you.

Published 6/2010, Copyright 2010,