Getting the Right Mobility Equipment & Services for People

with Disabilities March 27, 2014

Alexandra Bennewith, MPAVice President, Government Relations, United Spinal Association

Thank You To Our Sponsors

Who is United Spinal Association?

Roll on Capitol Hill, June 22-25, 2014

United Spinal Association’s Annual Legislative and Advocacy Conference

• United Spinal’s Public Policy department• NSCIA – United Spinal’s Membership and Chapter division• Users First – United Spinal’s grassroots advocates division

You can find more information at:http://www.unitedspinal.org/events/roll-on-capitol-hill/

What’s going on in Washington

Government funding•President’s Budget - March 4 and 11

•$400 billion in savings/cuts in Medicare

Physician payment cuts under Medicare • Congress thinking about permanent fix to physician payment

reform• Therapy caps exceptions process expires March 31

Health Reform• Affordable Care Act is 4 years old this month

• Access to DME, medical supplies and prescription drugs

What does this mean for us?• We/you must be part of the dialogue

o Make your voices heard

• Congressional offices have to hear from us/youo Tell Congressional offices our/your stories

• If they don’t hear from us/you, they don’t know what our/your concerns areo May lead to additional cuts to the equipment and

services you need

http://www.unitedspinal.org/action-center/http://www.unitedspinal.org/action-center/policy-priorities/

UsersFirst

Jenn Wolff, OTManager, UsersFirstjwolff@usersfirst.org

UsersFirst Mobility Map

First , things first:What do YOU want to do with

your wheelchair?

Step 1 is a Self Assessment, a checklist of what you want to do in your chair, what you like or dislike about your current chair and what physical issues should be addressed.

UsersFirst Mobility Maphttp://www.usersfirst.org/resources/mobilitymap/

• Who is your team?– Physician writes the order– Therapist and supplier should

complete the evaluation together and do a home evaluation, especially if it is going to be a different chair

– Supplier will order the chair– Find funding sources at

www.usersfirst.org!

UsersFirst Mobility Map

• When your chair is delivered– Ask to have it delivered to your

home! Do your typical routine to make SURE the new chair is going to work for YOU

– If you have any doubts, don’t sign for the chair!

– You have a RIGHT to the RIGHT equipment!

AIM CoalitionAccess. Independence. Mobility.

Wheelchair repair is essential to your mobility, your independence, your ability to contribute to, and participate in society.

However, your access to wheelchair repair services is being restricted by Medicare’s policies.

It is critical that you have access to a Medicare supplier with trained and experienced service technicians and the infrastructure and inventory to be able to repair the equipment you rely on.

Stay tuned for a United Spinal survey on wheelchair repair next week!

What is Complex Rehab Technology?

Products and services, including medically necessary individually configured manual and power wheelchair systems, adaptive seating systems, alternative positioning systems, and other mobility devices that require evaluation, fitting, design, adjustment and programming.

Such technology is designed to meet the specific and unique medical and functional needs of an individual with primary diagnoses resulting from a congenital disorder, progressive or degenerative neuromuscular disease, or from an injury or trauma.

CRT Legislation Specifics• CRT is used by individuals with disabilities and chronic conditions who have

medical conditions significantly different from those experienced by the traditional elderly population in Medicare.

• CRT requires a broader range of services and specialized personnel than those required for standard DME. The CRT company is also required to repair the equipment it provides.– requires a home evaluation of the individual’s functional mobility needs to

include a technology assessment, measuring, fitting, simulations and trials, a mixing and matching of products from different manufacturers, significant training and education, refitting and ongoing additional modifications.

• The Medicare program has established quality standards that all DME companies must meet to qualify for the Medicare program. Under this benefit, additional and more rigorous quality standards will be in place with which CRT companies must comply.

• CRT would be covered for people transitioning from skilled nursing facilities to the home and community. This bill exempts CRT products from Medicare’s ‘in-the-home restriction’ which covers mobility devices only if used inside a person’s home and rightly allows people to use their mobility devices to remain active members of their community.

Complex Rehab Technology Medicare Separate Benefit

Medicare currently does not have unique coverage for the more complex needs of individuals with disabilities and chronic medical conditions requiring customized products and services that are medically necessary.

In the interest of quality healthcare and optimal functionality for individuals with disabilities and chronic medical conditions, a separate Medicare benefit category must be established.

Complex Rehab Technology:What’s the message?

• Ask your Representative to co-sponsor HR 942/S. 948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 that would create a separate benefit category for Complex Rehab Technology

Competitive Acquisition Program:What is it?

http://www.medicare.gov/what-medicare-covers/part-b/durable-medical-equipment.html

• Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) required bids to be submitted to select a limited number of suppliers to provide and service certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

• First round was initiated in 10 cities in July 2008, (stopped after two weeks), Round One Rebid began on January 1, 2011

• Program expanded to 91 additional cities on July 2013, plans to go nationwide after 2015

CAP Affected Cities –Round One Rebid

• Cincinnati – Middletown (Ohio, Kentucky and Indiana)• Cleveland – Elyria – Mentor (Ohio)• Charlotte – Gastonia – Concord (North Carolina and

South Carolina)• Dallas – Fort Worth – Arlington (Texas)• Kansas City (Missouri and Kansas)• Miami – Fort Lauderdale – Pompano Beach (Florida)• Orlando (Florida)• Pittsburgh (Pennsylvania)• Riverside – San Bernardino – Ontario (California)

CAP Product Categories –Round One Rebid

• Oxygen Supplies and Equipment• Standard Power Wheelchairs, Scooters, and Related

Accessories• Complex Rehabilitative Power Wheelchairs and Related

Accessories (Group 2)• Mail-Order Diabetic Supplies• Enteral Nutrients, Equipment and Supplies• CPAP, RADs, and Related Supplies and Accessories• Hospital Beds and Related Accessories• Walkers and Related Accessories• Support Surfaces (Group 2 mattresses and overlays) in

Miami

CAP Affected Cities - Round TwoNORTHEAST

Albany-Schenectady-Troy, NYAllentown-Bethlehem-Easton, PA-NJBoston-Cambridge-Quincy, MA-NHBridgeport-Stamford-Norwalk, CT

Buffalo-Niagara Falls, NYHartford-West Hartford-East Hartford, CT

New Haven-Milford, CTNew York-Northern New Jersey-Long Island, NY-NJ-PA

Philadelphia-Camden-Wilmington, PA-NJ-DE-MDPoughkeepsie-Newburgh-Middletown, NYProvidence-New Bedford-Fall River, RI-MA

Rochester, NYScranton-Wilkes-Barre, PA

Springfield, MASyracuse, NY

Worcester, MA

CAP Affected Cities - Round Two

WEST

Albuquerque, NMBakersfield-Delano, CABoise City-Nampa, IDColorado Springs, CODenver-Aurora-Broomfield, COFresno, CAHonolulu, HILas Vegas-Paradise, NVLos Angeles-Long Beach-Santa Ana, CAOxnard-Thousand Oaks-Ventura, CAPhoenix-Mesa-Glendale, AZ

Portland-Vancouver-Hillsboro, OR-WASacramento-Arden-Arcade-Roseville, CASalt Lake City, UTSan Diego-Carlsbad-San Marcos, CASan Francisco-Oakland-Fremont, CASan Jose-Sunnyvale-Santa Clara, CASeattle-Tacoma-Bellevue, WAStockton, CATucson, AZVisalia-Porterville, CA

CAP Affected Cities – Round TwoMIDWEST

Akron, OHChicago-Joliet-Naperville, IL-IN-WI

Columbus, OHDayton, OH

Detroit-Warren-Livonia, MIFlint, MI

Grand Rapids-Wyoming, MIHuntington-Ashland, WV-KY-OH

Indianapolis-Carmel, INMilwaukee-Waukesha-West Allis, WI

Minneapolis-St. Paul-Bloomington, MN-WIOmaha-Council Bluffs, NE-IA

St. Louis, MO-ILToledo, OHWichita, KS

Youngstown-Warren-Boardman, OH-PA

CAP Affected Cities – Round TwoAsheville, NC

Atlanta-Sandy Springs-Marietta, GAAugusta-Richmond County, GA-SCAustin-Round Rock-San Marcos, TX

Baltimore-Towson, MDBaton Rouge, LA

Beaumont-Port Arthur, TXBirmingham-Hoover, AL

Cape Coral-Fort Myers, FLCharleston-North Charleston-Summerville,

SCChattanooga, TN-GA

Columbia, SCDeltona-Daytona Beach-Ormond Beach, FL

El Paso, TXGreensboro-High Point, NC

Greenville-Mauldin-Easley, SCHouston-Sugar Land-Baytown, TX

Jackson, MSJacksonville, FLKnoxville, TN

Lakeland-Winter Haven, FLLittle Rock-North Little Rock-Conway, AR

Louisville/Jefferson County, KY-INMcAllen-Edinburg-Mission, TX

Memphis, TN-MS-ARNashville-Davidson-Murfreesboro-Franklin,

TNNew Orleans-Metairie-Kenner, LANorth Port-Bradenton-Sarasota, FL

Ocala, FLOklahoma City, OK

Palm Bay-Melbourne-Titusville, FLRaleigh-Cary, NC

Richmond, VASan Antonio-New Braunfels, TX

Tampa-St. Petersburg-Clearwater, FLTulsa, OK

Virginia Beach-Norfolk-Newport News, VA-NCWashington-Arlington-Alexandria, DC-VA-

MD-WV

SOUTH

CAP Product Categories –Round Two

• Oxygen, oxygen equipment, and supplies• Standard (Power and Manual) wheelchairs, scooters, and related

accessories• Enteral nutrients, equipment, and supplies• Continuous Positive Airway Pressure (CPAP) devices and

Respiratory Assist Devices (RADs) and related supplies and accessories

• Hospital beds and related accessories• Walkers and related accessories• Negative Pressure Wound Therapy pumps and related supplies

and accessories• Support surfaces (Group 2 mattresses and overlays)

Consumer Impacts• Difficulty finding a local equipment or service provider

• Delays in obtaining medically required equipment and services (i.e. wheelchair repair)

• Longer than necessary hospital stays due to trouble discharging patients to home-based care

• Far fewer choices for patients when selecting equipment or providers

• Reduced equipment, parts and service quality; and

• Confusing or inaccurate information provided by Medicare

Support fixing CAPCurrent Program Problems:• Winning suppliers are NOT bound by their bids

to provide DME

• Irresponsibly low supplier payment rates affecting your access to your choice of quality equipment and services

• No transparency in how suppliers win contracts or how consumer demand is calculated

Competitive Bidding: What’s the Message

• Tell you Representative to support HR 1717 Medicare DMEPOS Market Pricing Program Act of 2013 which will fix Medicare’s current bidding program through market-based pricing, protect people with disabilities’ access to medically necessary medical equipment and related services and ensure that individuals with disabilities receive high-quality service and equipment that will give our community the ability to live active, productive independent lives with improved health outcomes.

• Stay tuned for Senate legislation

Outpatient Rehab PaymentsMedicare arbitrarily caps at $1,920 annual payments for outpatient occupational therapy and outpatient physical

therapy and speech therapy combined

• An extension of the therapy cap “exceptions” process allows Medicare beneficiaries to seek waivers to exceed the annual limit for medically necessary services

• Failing the development by CMS of a fair payment method, this exceptions process has required enactment of annual exceptions legislation since 1997

• As of yesterday, the exceptions process was going to end March 31, 2014. NEW: 3/27, this morning - one year extension voted on by the House! Senate will vote later.

Outpatient Rehab Payments• Congressmen Jim Gerlach (R-PA) and Xavier Becerra (D-CA) and

Senators Ben Cardin (D-MD) and Susan Collins (R-ME) introduced The Medicare Access to Rehabilitation Services Act of 2013 (HR 713/S 367).

• The bill would repeal the arbitrary Medicare Part B outpatient therapy caps now affecting an estimated 640,000 Medicare beneficiaries being denied access to needed services

• Ending the therapy cap would ensure that Medicare beneficiaries recovering from spinal cord injury and disorders receive the therapy they need to live productive, independent lives and avert costing Medicare more due to increased hospitalizations

Outpatient Rehab Payments: What’s the Message?

• Urge your Representative and Senators to co-sponsor HR 713/S 367 to eliminate Medicare’s arbitrary and unfair outpatient rehab therapy payment caps

Access to Prescription Drugs and Medical Supplies

• Prescription Drugs - United Spinal advocates for expanded access to prescription drugs

• Medical Supplies (diabetic supplies, urological supplies)– United Spinal has launched the Urology Coalition

Prescription Drugs and Medical Supplies: What’s the Message?

• Tell your Representative/Senator your story about your needs for prescription drugs and medical supplies

Achieving a Better Life Experience Act of 2013 (ABLE Act)

Tax-exempt savings accounts can be used for the following:

•Education•Housing•Transportation•Employment Support•Health, Prevention and Wellness•Assistive Technology/Personal Support Services•Miscellaneous Expenses (financial management and administrative services; legal fees; home improvements and modifications, maintenance and repairs)•Assistive Technology/Personal Support Services•Other Approved Expenses

ABLE Act: What’s the Message?

• Ask your Representative/Senator to co-sponsor HR 647/S.313 which will help individuals and families save private funds to support people with disabilities for the purpose of maintaining their health, independence, and quality of life.

Transportation Equity

Carol TysonSenior Policy Associate

DC Taxi Commission Disability Advisory Committee Co-Chair

Vice-chair, Consortium for Citizens with Disabilities Transportation TaskforceSteering committee, Transportation Equity Caucus

Transportation Equity• People with disabilities rely on transportation, traditional and alternative modes,

to travel to their jobs, school and medical appointments, participate and contribute in their social and religious communities, visit family members, participate in exercise, and, most significantly, live independently in the setting they choose. United Spinal has a long history of advocating for equal access to transportation.

• The Americans with Disabilities Act, the Air Carrier Access Act and Rehabilitation Act all provided groundbreaking access to transportation, including airlines, public buses, and sidewalks. All of these measures ensure a floor, not a ceiling.

• People with disabilities continue to lack access to transportation. Adults with disabilities are twice as likely as those without disabilities to have inadequate transportation (31 percent versus 13 percent). According to a 2002 Department of Transportation report, nearly 530,000 people with disabilities never leave their homes because they experience transportation difficulties.

• United Spinal continues to advocate for transportation equity policies that offer universal design approaches across all modes and address the needs of all underserved communities: including people of color, low income communities, women, and people with disabilities.

Transportation Equity: What’s the message?

• Tell your Representative/Senator to support HR 3494/S1708, Bicycle and Pedestrian Safety Act.These bills would require the DOT to set a non-motorized safety performance measure.

• Tell your Representative/Senator to support HR 3978, New Opportunities for Bicycle and Pedestrian Infrastructure Financing Act (NOBPIFA). The bill includes funding for projects to achieve compliance with the ADA.

Get Involved and Make a Difference• Become a member of United Spinal Association

www.unitedspinal.org

• Join United Spinal Association’s Team Advocacy www.unitedspinal.org – visit our Advocacy Action Center

• Join a chapter/support group www.spinalcord.org

• Be a policy advisor at your chapter/support groupwww.spinalcord.org

• Be a grassroots advocatewww.usersfirst.org

More Ways to Get Involved• Attend a town hall hearing/meeting in your state

• Find your Senator at www.senate.gov and your Representative at www.house.gov

• Call U.S. Capitol Switchboard: (202) 224-3121

• Or you can

Senator Tom Harkin (D-IA), Chair, Senate HELP Committee

Roll on Capitol Hill, June 22-25, 2014

United Spinal Association’s Annual Legislative and Advocacy Conference

• United Spinal’s Public Policy department• NSCIA – United Spinal’s Membership and Chapter division• Users First – United Spinal’s grassroots advocates division

You can find more information at:http://www.unitedspinal.org/events/roll-on-capitol-hill/

Upcoming Webinars• May 22 - Ensuring Quality Services and Supports under Medicaid

Carol Tyson, United Spinal Association2-3pm ET

• June 17 - Transitioning into Adulthood with SCI/D Lawrence C. Vogel, MD - Shriners Hospitals for Children and Rush Medical College1-2 pm ET

• July 24 - Fight to Improve Wheelchair Access in NYC and Its National Implications James Weisman, United Spinal Association and Margi Trapani, Center for Independence of the Disabled, New York's (CIDNY)3-4pm ET

http://www.spinalcord.org/webinar-archive/

THANK YOUQUESTIONS?

To ask me a question or make a comment, please type it in the

“Questions” box

abennewith@unitedspinal.org(202) 556-2076, x.7102