I lead a fairly typical life for a young adult. I attended my local public high school, participated in sporting events, went to dances and did endless amounts of homework. After high school, I attended and earned my degree at a wonderful liberal arts school. I lived in the dorms and schlepped across campus on snow-covered sidewalks just like everyone else. I worked on campus and did my internships at a middle school and local non-profit. I was active in numerous clubs and organizations and, when it came time to graduate, proudly accepted my diploma and the college president’s leadership award. I was able to do all these things, and so much more because of my power wheelchair(s), I have been driving since I was eighteen months old. My physical limitations are such that a power chair has always been the best way for me to navigate and allows me the freedom and independence I deserve.
For other individuals with mobility difficulties, sometimes a manual chair provides the best means of freedom. With over 1.7 million wheelchair users in the United States, about 90% of us use manual chairs. Currently, though, manual wheelchair users covered under Medicare/Medicaid don’t have equal access to customizable wheelchairs as those with customized power chairs. The problem? Competitive bidding.
What is Competitive Bidding?
Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program changes the amount Medicare pays for certain DMEPOS items. This program requires suppliers to submit bids to provide certain medical equipment and supplies to people with Medicare/Medicaid living in, or visiting, certain areas. The program only applies to people with certain types of Medicare/Medicaid who live in certain, largely, metropolitan areas around the country. This means if someone needs a complex (customized) manual wheelchair, standing device, gait trainer or another item, they are forced to use the company that gives Medicare the lowest estimate, even if it is not the best company or product for the consumer.
Equal Access for All
I have many friends who use both manual and power chairs, and some of their chairs barely function. However, because it is the only chair Medicaid/Medicare would cover, they are stuck with something that doesn’t work well for their health needs and abilities. Everyone should have access to the least restrictive environment possible. Manual chairs (and other devices and accessories) are no less essential than the power wheelchairs currently exempt from the competitive billing program. Everyone requires, and deserves, the equipment that works best for their needs and properly fits them, not whichever is cheapest. By not adequately covering customizable medical equipment, insurance companies do not save money in the long run, as they claim. Medical equipment is like anything else, if you buy the cheapest version of a product, you’re going to get what you pay for.
Everything that is customized for an individual’s chair is medically necessary. Each piece of equipment must be justified by medical professionals and necessary for the patient’s well-being. If someone’s adaptive equipment is not properly fitted to them, it can cause health problems such as pressure sores and exacerbate other issues such as spinal distortion and breathing problems. In the long run, poorly fitted equipment will cost insurance companies more because consumers will likely require additional care from the resulting medical problems. The average bill for a hospital stay for pressure sores is around $124,327; at least five times the cost of buying a properly customized wheelchair that would prevent such health issues from occurring in the first place.
What is being done?
In 2008, Congress passed the Medicare Improvements for Patients and Providers Act (MIPPA) to amend parts of the Social Security Act, including the use of Medicare’s competitive bidding program. The language in MIPPA specifies an exemption from competitive bidding for “Complex Power Wheelchairs (group 3 and above) and related accessories,” because, at the time, it was the only type of chair being competitively bid. Congress thought it was best to be specific to protect power wheelchair users so Congress limited the language to that entity.
It was not until later that Medicaid/Medicare reclassified customizable manual wheelchairs (and other durable medical equipment) as competitive bid items. Now, advocates are calling on Congress to support H.R. 3730, a bill that would protect both customizable power and manual wheelchairs from any competitive bidding program. There is also another bill, H.R. 750 which would create a separate benefit category for Complex Rehab Technology (CRT) within the Medicare program. This would protect people with disabilities access to critical equipment and related services. A separate CRT category will allow for needed improvements in coverage policies, coding, and quality standards to better address the unique needs of people with significant disabilities and chronic medical conditions who rely on these specialized products to manage their medical needs, minimize their health care costs and maximize their function and independence.
We must urge our representatives to support, and pass both H.R. 3730 to protect both manual and power wheelchair users, and H.R. 750 which will protect all users of customizable durable medical equipment. It will save money in the long run and enable disabled individuals the ability to participate in society. Ensuring people’s ability to safely and easily navigate will mean more people can work, shop and contribute to the economy. Everyone deserves freedom, stop dividing the wheelchair community.
Erin Vallely lives with a rare form of muscular dystrophy and is a proud wheelchair user. Having graduated with a B.A. in Sociology and Anthropology with a Spanish minor from Wells College in Aurora, NY, she plans to pursue a career in disability rights advocacy and possibly politics. In her spare time, Erin enjoys reading about other people’s experiences, supporting other minority groups, and traveling.