Limited Movement

Medicare policy changes could leave wheelchair users stuck at home

For the ambulatory, the south side of Speedway Boulevard east of Alvernon Way is just another strip of gradually undulating asphalt and concrete in front of nondescript stores. But for those in wheelchairs, this pavement is a daunting obstacle course featuring numerous driveways scattered among a terrain which slopes precariously toward an onrushing stream of cars exceeding the 35 mph speed limit.

Abby Road has been in a wheelchair for more than a decade because of arthritis and a degenerative bone disease, and the 44-year-old is fighting to maintain her ability to navigate along streets like Speedway. But because of recent changes in regulations of the federal government's Medicare program, she's pessimistic.

"Will they make the world flat for me?" asks Road, who asked that we not use her real name.

Using a highly technical, 300-pound wheelchair that costs in excess of $12,000, Road is now able to get around on her own. The chair has special features recommended by her physician, such as a shock fork suspension system to minimize jostling.

"The chair also has power to control its stability on inclines," Road points out, "and is strong enough to relieve pressure on my chest when it tilts back, plus it relieves pressure on my arms. I can change positions without struggling."

Last November, however, Medicare regulations for powered wheelchairs were significantly revised, affecting large numbers of people like Road.

Medicare cited numerous cases in which the government was charged more for a power wheelchair than the supplier paid for it. A report prepared for Medicare showed this fraud helped increase federal expenditures for the equipment from $43 million in 1995 to $1.2 billion eight years later.

The new rules have severely restricted the types of powered wheelchairs for which Medicare will pay. In general, this change means wheelchair features will now only be allowed for "in-the-home" necessity even more strictly than in the past, while reducing the amount Medicare will pay equipment providers.

Stressing the fraud problem, Medicare spokeswoman Ellen Griffith says simply: "The (equipment) providers don't like the changes."

Congressman Raúl Grijalva thinks a hard look has to be taken at the new requirements.

"There a real burden on people," he says. "We should keep the safeguards against fraud in place, but need to consider repealing the restrictions."

Also not approving of the revisions is the ITEM Coalition (Independence Through Enhancement of Medicare and Medicaid), a Washington, D.C.-based lobbying group. Calling the changes "disastrous" for many wheelchair users, the group wrote Michael Leavitt, secretary of the Department of Health and Human Services, stating the new restrictions "will inevitably force many individuals with disabilities into low-functioning, inappropriate and often unsafe wheelchairs, threatening opportunities for independent living."

This dire prediction applies especially to people like Road, who lives on less than $640 a month. She is eligible for both Medicare and AHCCCS, Arizona's low-income medical-insurance program, and her chance of "buying up" from the Medicare-approved wheelchair is nil since she doesn't have the money.

"Just because I'm eligible for both Medicare and AHCCCS," Road's observes, "doesn't mean I'm entitled to less rights."

While AHCCCS officials say they will evaluate a person's medical necessity for a sophisticated motorized wheelchair before deciding whether to pay the difference between its cost and the amount Medicare will supply, both Road and her equipment provider doubt that will happen.

"If it's not covered under Medicare," says Carl Foster of Dependable Health Services, "AHCCCS doesn't have to pay, and they usually follow Medicare."

Foster--stressing that his opinions are his own and not those of the company he works for--adds of the people these new restrictions will impact: "My belief is they don't know about (the new restrictions). ... These people are dealing with a loss of mobility, and this is one more complexity they have to deal with."

As for the charges of widespread fraud by power wheelchair providers, Foster responds: "That's ridiculous and a joke." He admits there were specific cases of fraud in Texas and California, but adds: "There are always going to be some greedy people out there, but as an industry as a whole--no way!"

Instead of making its power wheelchair guidelines more restrictive, Foster believes Medicare should get rid of its "in-the-home" rule because it is so discriminatory, and thinks things are slowly moving in that direction.

Foster also says motorized wheelchairs are expected to last at least five years, and after that, they are evaluated until maintenance costs increase to a point where "you're throwing good money at bad equipment."

That is the concern of Road, whose wheelchair is more than 7 years old, and was just out of service for several months so costly repairs could be made to it. She used a less desirable wheelchair during that period, and fears that when her current chair finally needs to be replaced, she'll end up with a less useful piece of equipment.

"I won't be able to be what I want to be," Road's says of the volunteer work she now does. "Why should the taxpayers pay for me to be bedridden?"

If Medicare won't pay to replace her wheelchair with at least a similar one, Road conjectures: "I'll sit on the side of the road with a sign which says--'Save Abby's Wheelchair, Because Medicare Won't.'"

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