Federal health officials defended a demonstration program that requires Medicare pre-authorization for power wheelchairs in a Senate hearing on Wednesday.
The demonstration program requires Medicare providers and beneficiaries to get authorization from a Medicare contractor before the wheelchair or electric scooter can be delivered. Officials from Centers for Medicare & Medicaid Services told members of the Senate Special Aging Committee that the program is needed because 80% of the claims submitted for wheelchairs fail to meet Medicare requirements for coverage, the Associated Press reported. CMS officials said this results in over $492 million in improper payments every year. Scooters and motorized chairs can range in price from $1,500 to $3,600, according to the AP.
Wheelchair suppliers, however, said that the CMS program overreaches. Michael Clark, an attorney representing the Scooter Store, testified that since the policy was implemented, every claim the Scooter Store submitted was denied.
Sen. Bob Corker (R-TN), the ranking Republican member of the committee, said television advertisements for motorized chairs and scooters can give consumers the wrong impression about the ease with which Medicare coverage can be gained.
“I think most Americans have seen these advertisements on TV and probably question what the federal government is doing,” Corker said.
Medicare rules require a beneficiary to have a face-to-face meeting with the prescribing physician before it will authorize a claim. Under the Affordable Care Act, CMS has used competitive bidding programs to reduce expenditures on durable medical equipment for products such as wheelchairs. This demonstration program started in seven states on Sept. 1.
Click here to listen to hearing testimony.