Stop Implementation of Harmful Medicare Policies!

Regulations Limiting Access to Assistive Devices: Medicare just published its new local coverage determinations (LCDs) for power mobility devices (PMDs). Unfortunately, this new policy is even more restrictive. It will severely limit access to the most appropriate assistive devices for individuals with mobility impairments.

The new policy has an even more restrictive interpretation of the “in the home” requirement. This will prevent many people from receiving devices that could be used outside the home.

Take Action to Improve Access to Assistive Devices! Medicare must recognize the importance of access to assistive technology for people with disabilities! The policy is scheduled to go into effect on November 15, 2006. Contact your members of Congress today and urge them to delay the implementation of this restrictive LCD policy and support legislation to improve access to assistive devices!

What can you do to help?

Contact your members of Congress today to urge them to delay the implementation of the new LCDs and support S. 3677!

You can contact your members of Congress via the Capitol switchboard toll-free at 1-877-224-0041 or via e-mail.

A sample call script and e-mail is included below.

• To find your representative: click here.
• To find your senator, go to: click here.

Sample Call Script

Hello. May I please speak with Representative/Senator_____? (You will be asked to leave a message.)

My name is _____. I live in his/her district. I am calling in regard to Medicare’s new local coverage determinations (LCDs) for power mobility devices. These regulations are very restrictive to people with disabilities. I am urging him/her to ask Medicare to delay implementation of the LCDs. There is a bill in Congress right now, S. 3677, the “Medicare Independent Living Act of 2006,” that addresses these issues.

I urge Representative/Senator to support this important legislation and work to improve access to assistive devices, so people with disabilities are able to lead independent, productive lives.

(They will probably ask for your name and address. It is very simple and only takes a couple of minutes. )

Sample E-mail

Dear Representative/Senator ______,

I am writing in response to Medicare’s new local coverage determinations (LCDs) for power mobility devices. The new policy will severely limit access to the most appropriate assistive devices for individuals with mobility impairments. This will prevent many people from receiving devices that could be used outside the home to go to school, work and medical appointments.

Medicare needs to recognize the importance of access to assistive technology for people with disabilities! The policy is scheduled to go into effect on November 15, 2006. I urge you to support delaying the implementation of the new LCD policy and to support legislation to improve access to assistive devices.

Right now, Senator Bingaman is advancing S.3677, the “Medicare Independent Living Act of 2006.” This bill would modify Medicare’s restriction on “in the home” mobility devices such as wheelchairs and scooters. Currently, the language regarding mobility devices is considered coverage for needs in the home. That means that they restrict coverage to only those mobility devices that are being used in the patient’s residence. This has a very negative impact on people who may be able to get around in their own home without a wheelchair or scooter but require an assistive device if they want to leave their home.

We must work to ensure that people with disabilities have the means to lead full and independent lives. Please, work to delay the implementation of the new Medicare LCDs and support positive legislation like S. 3677, which appropriately addresses the needs of people with disabilities.

Sincerely,

Name, Address

Summary of the new Medicare policy: click here.

For more information about bill S.3677 and to track its progress: click here.

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PA House Bill (HB) Hearing a Great Success!

On Thursday, October 19, the Pennsylvania Health and Human Services Committee heard HB 2718, a bill requiring insurance companies to cover prosthetic devices and components.

The hearing was a great success. Private individuals and practitioners from across the state came out in support of this important bill. Both the Vice Chair, Rep. Fred McIlhattan, and the primary sponsor, Rep. Bernie O’Neill, publicly stated a goal of passing this legislation in 2007.

“My challenge to Fred is to pass this bill by June of 2007,” says Rep. O’Neill.

“My goal is to pass this legislation by the end of 2007,” added Rep. McIlhattan

Next Steps: The Pennsylvania legislature will adjourn for the year on November 30. It is unlikely that the bill will proceed in the next month; however, with such strong support from the committee, we are gearing up to reintroduce this bill in January and continue to move this bill forward.

Mark Your Calendars: We are working with Rep. Bernie O’Neill to organize a rally in support of prosthetic coverage in January! More details to come soon!

Thank you! Thank you to all of the Pennsylvania activists who made phone calls, wrote letters and sent e-mails to their representatives and the committee members. This has truly made a difference! We will definitely need your continued assistance and dedication in the coming months as we work to pass this important bill into law!

We are excited about the results of Thursday’s hearing. We are looking forward to continued opportunities to advance this legislation!

To view a photo of the hearing, click here.

Testimony was given by:

Michael and Sean Brame
Sean lost both his legs and one of his arms as a result of an infection. He and his father testified about the importance of covering care for growing children to enable them to lead active lives.

Georgia Foltz, RN
Georgia is a case manager for Workmen’s Compensation and an amputee. She is very active in the Amputee Support Team (AST). She spoke about the need to look at the long-term costs of refusing prosthetic care, such as lost wages and secondary conditions.

Garry Moore
Garry is a project manager for Adaptive Action Sports and the captain of Amped Riders. He was recently informed that his insurance company has a $7,000 lifetime cap on his prosthetic care. This has made it very difficult for him to find and keep a job and be there for his two small children. He talked about the importance of providing people the care they need in return for the high premiums that they pay to insurance companies.

John Rush, MD
Dr. Rush is the chief medical officer for Hanger Orthopedic, Inc. He talked about the research and cost estimates that have been done on prosthetic coverage, showing that this benefit is not only low-cost, but also results in medical savings in the long run.

Morgan Sheets
Morgan is the national advocacy director of the Amputee Coalition of America. She talked about polling and surveys that were conducted by the ACA at the state and national level, demonstrating the need for coverage as well as the various ways that coverage is currently being limited. She also shared additional research on the cost benefit of providing prosthetic care.

Read more!

CALL TO ACTION: Virginia's Fight for Prosthetic Coverage

You are probably aware that an increasing number of people living with the loss or absence of a limb face daunting obstacles from third-party payers when trying to obtain the prosthetic care they need to enable them to return to an active, productive lifestyle. That is why the Amputee Coalition of America (ACA) is working with activists across the country to introduce legislation requiring the coverage of prosthetic devices and components.

Making Progress: With help from the ACA and its members, Rhode Island, California and Massachusetts all passed legislation in 2006.

In Your State: The ACA is working with patients, practitioners and activists to start a campaign for prosthetic coverage in Virginia! We need your help!

YOU CAN HELP!
Join the campaign: People like you are working to pass legislation in Virginia. There are many ways you can help, through letters, phone calls and e-mails. To find out more about how you can get involved in the Virginia campaign, contact us at: appll@amputee-coalition.org!

Spread the Word: Help us spread the word by sending a letter to your representative, explaining the need for legislation to protect access to prosthetic coverage. This will help educate your legislator and demonstrate public support.

• Click here to find your representative.
• We have included a sample letter below for your convenience.

SAMPLE LETTER

Dear Representative/Senator ____,

Without legislation to ensure coverage, many people living with the loss or absence of a limb face discouraging obstacles when trying to obtain prosthetic care. That is why local patients, doctors and other community leaders are working with the Amputee Coalition of America (ACA) in pushing for a bill for prosthetic coverage.

Obviously, the biggest concern anyone has about passing a new mandate is cost. People fear that big jumps in the cost of insurance will reduce access to healthcare. None of us want to see health insurance costs pushed beyond the reach of the average consumer. In actuality, the public sector would see savings because appropriate private insurance coverage prevents shifting costs to the public sector. Our best financial data to support this comes from Colorado. They were the first state to pass prosthetic parity legislation in 1998.

A Department of Health Care Policy & Financing report found that the maximum increase in premiums for prosthetic provision would be about 12 cents per month. That’s less than $1.50 per year. That’s not going to push anyone off the insurance rolls or put anyone out of business. It will, however, get people the care they need to get back to work and live independent, productive lives.

Subsequent reports in Massachusetts and California also found that the cost to cover prosthetic devices would be minimal and would actually result in savings to the public and private sector. Both of these states passed bills requiring coverage in 2006.

Many hard-working people in Virginia are prevented from living full lives because they cannot get the care they need. I hope you will support the bill for prosthetic coverage!

Sincerely,

Name, Address, Phone

Read more!

CALL TO ACTION: Washington's Fight for Prosthetic Coverage!

You are probably aware that an increasing number of people living with the loss or absence of a limb face daunting obstacles from third-party payers when trying to obtain the prosthetic care they need to enable them to return to an active, productive lifestyle. That is why the Amputee Coalition of America (ACA) is working with activists across the country to introduce legislation requiring the coverage of prosthetic devices and components.

Making Progress: With help from the ACA and its members, Rhode Island, California and Massachusetts all passed legislation in 2006.
In Your State: The ACA is working with practitioners and activists to start a campaign for prosthetic coverage in Washington! We need your help!

YOU CAN HELP!

Join the campaign: People like you are working to pass legislation in Washington. There are many ways you can help, through letters, phone calls, and e-mails. Contact us today to find out more about how you can get involved in the Washington campaign (appll@amputee-coalition.org)!

Donate: As we work to advance prosthetic coverage, we need the financial support of our members and supporters.

• Support our efforts to advance prosthetic coverage in Washington by clicking here. ANY AMOUNT HELPS!

Spread the Word: Help us spread the word by sending a letter to your representative, explaining the need for legislation to protect access to prosthetic coverage. This will help educate your legislator and demonstrate public support.

• Click here to find your representative.

• We have included a sample letter below for your convenience.

SAMPLE LETTER

Dear Representative/Senator ____,

Without legislation to ensure coverage, many people living with the loss or absence of a limb face discouraging obstacles when trying to obtain prosthetic care. That is why local patients, doctors and other community leaders are working with the Amputee Coalition of America (ACA) in pushing for a bill for prosthetic coverage.

Obviously, the biggest concern anyone has about passing a new mandate is cost. People fear that big jumps in the cost of insurance will reduce access to healthcare. None of us want to see health insurance costs pushed beyond the reach of the average consumer. In actuality, the public sector would see savings because appropriate private insurance coverage prevents shifting costs to the public sector. Our best financial data to support this comes from Colorado. They were the first state to pass prosthetic parity legislation in 1998.

A Department of Health Care Policy & Financing report found that the maximum increase in premiums for prosthetic provision would be about 12 cents per month. That’s less than $1.50 per year. That’s not going to push anyone off the insurance rolls or put anyone out of business. It will, however, get people the care they need to get back to work and live independent, productive lives.

Subsequent reports in Massachusetts and California also found that the cost to cover prosthetic devices would be minimal and would actually result in savings to the public and private sector. Both of these states passed bills requiring coverage in 2006.

Many hard-working people in Washington are prevented from living full lives because they cannot get the care they need. I hope you will support the bill for prosthetic coverage!

Sincerely,

Name, Address, Phone

Read more!

CALL TO ACTION: Prosthetic Coverage Bill to Be Heard October 19!

On Thursday, October 19, the Pennsylvania Health and Human Services Committee will hold a public hearing for HB 2718. Sponsored by Rep. Bernie O’Neill, this bill will require insurance companies to cover prosthetic devices and components.

The momentum behind this bill has really increased over the past few months. We have had letters printed in support of this legislation in 10 different newspapers across the state.

We need your help to keep this bill moving forward!

Click here to contact the Health and Human Service Committee members today to urge them to support this important legislation.


Sample letter

Dear Representative ____,

I am writing in response to HB 2718, a bill for prosthetic coverage. In return for premiums paid for group health insurance, consumers expect to be covered for catastrophic illness or injury. Sadly, without legislation to ensure coverage, many people living with the loss or absence of a limb face discouraging obstacles when trying to obtain prosthetic care. Current changes in insurance plans are having a devastating effect on amputees and their families.

Current changes in insurance plans are having a devastating effect on amputees and their families. Companies are imposing such unrealistic annual and lifetime caps on prosthetic coverage that people with limb loss are unable to obtain prostheses. Obviously, the biggest concern anybody has about passing a new mandate is cost. None of us want to see health insurance costs pushed beyond the reach of the average consumer. However, reports from California, Colorado and Massachusetts prove that is not the case. They have all shown that prosthetic coverage costs just pennies per month and actually results in medical savings.

Both the financial and social benefits provide a strong case for prosthetic coverage. Three states have passed bills requiring prosthetic coverage since July of this year: Rhode Island, California and Massachusetts. Another dozen states are working to advance similar legislation.
People all across Pennsylvania have come out in support of this bill. And 10 different newspapers have published letters in support of HB 2718. I urge you to support HB 2718 when it comes before the Health and Human Services Committee in October.
Sincerely,
Name, Address, Phone

For more information, contact us at APPLL@amputee-coalition.org or 202/742-1885.

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NEWS: Governor Schwarzenegger Signs Prosthetic Coverage Bill for CA

Governor Schwarzenegger Signs Prosthetic Coverage Bill--California Joins National Trend in Protecting Access to Prosthetic Care

On September 30, California became the sixth state to protect prosthetic coverage under the law. Governor Arnold Schwarzenegger signed AB 2012, a bill that mandates that insurance plans offering benefits for orthotic and prosthetic (O&P) care must provide full coverage — without caps and co-pays that restrict access to prescribed devices. The new bill will make certain that insured, working people can continue working and supporting their families.

“Currently, when health plans and insurers offer orthotic and prosthetic coverage, they may offer coverage that in reality provides only a small portion of the total costs of a prosthetic limb,” says Gov. Schwarzenegger. “For instance, a health plan may only cover $2,000 of the cost of a prosthetic arm, leaving the patient to pay the remaining cost, which could be $10,000 or higher,” added Gov. Schwarzenegger.

The bill also mandates that O&P providers will have met a standard level of competency to fit and furnish devices and services by being nationally certified.

“My husband and I are thrilled with the passage of this bill,” says Anne Bahl, of Mountain View. “Now we have hope that our 15-year-old son, who lost his leg to cancer last year, will finally have access to adequate prosthetic coverage, both now and, even more importantly, in the future when he is on his own.”

The bill was sponsored by the California Orthotics and Prosthetics Association (COPA) and supported by the Amputee Coalition of America (ACA) and its members.

“We commend Gov. Schwarzenegger for supporting this important bill. People must get the care they need to lead independent, productive lives,” says Paddy Rossbach, CEO and President of the Amputee Coalition of America.

The ACA is part of a national campaign to advance legislation state-by-state requiring insurance companies to cover appropriate prosthetic care.

Read more!