Discussion Forum

From: United Spinal Association

Say No to Bidding– Support HR 6490

The bill with the funny name: HR 6490 – The Medicare DMEPOS Market Pricing Program Act of 2012, has some serious benefits for people with disabilities who cannot get critical equipment and services under Medicare’s current bidding program.

United Spinal Association needs your support to ensure HR 6490 is passed, so that Medicare beneficiaries––including wheelchair users and other people with disabilities––have access to high quality, durable medical equipment (DME), like wheelchairs, and other devices.

This type of equipment is far from a luxury, it’s a necessity! The right mobility equipment goes a long way in helping many people with disabilities live healthy and active lifestyles, and most importantly maintain their independence.  It also allows greater access to employment, educational and social opportunities.

Without the right DME products and services, our ability to access the community is significantly limited and restricts going to work, school or places of worship, physician visits and other medical services as well as taking care of grocery shopping or participating in other activities.

The Medicare DMEPOS Market Pricing Program Act of 2012 (HR 6490) was introduced in September 2012 by Congressman Tom Price from Georgia, who is also a physician.  DMEPOS stands for “durable medical equipment, prosthetics, orthotics, and supplies”.

This bill is proposing a new program called the Market Pricing Program (MPP) to replace Medicare’s current poorly designed bidding program. HR 6490 is a giant leap forward from the current bidding, which leaves many people with disabilities unable to get the equipment and services that they desperately need to live life to the fullest.

Pitfalls of Current Bidding Program Under the current bidding program, Medicare basically gets to choose what durable medical equipment providers its beneficiaries can use and also sets the equipment prices in large regional areas across the country.  This program restricts access to, and choice of, DME items and services by forcing consumers to use certain DME providers whether they furnish the products and services that provide the most benefit to consumers or not.

With fewer providers allowed to provide products and services, normal expedient deliveries of items and services are being eliminated and therefore Medicare costs are increasing because patients are being hospitalized for longer periods and may require more frequent physician visits.

Here’s a list of affected areas:

• 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)

If you live in these areas, you may have limited or no access to critical equipment and supplies, such as wheelchairs, walkers, oxygen therapy, enteral nutrients (tube feeding), continuous positive air pressure (CPAP) and respiratory assistive devices, hospital beds and support surfaces, as well as mail-order diabetic supplies.  Customized power wheelchairs, known as complex rehab technology, are exempt under MPP, as they are with the current bidding program.

Worst of all, if the current bidding program is allowed to continue, it will expand next July to 91 additional areas across the United States–– including the large metropolitan areas of Los Angeles, CA (including Long Beach and Santa Ana); Chicago, IL (including Indiana and Wisconsin); and New York (including northern New Jersey and Pennsylvania). The expanded program will also include wound therapy pumps and related supplies and accessories.

Bidding impacts individuals with significant disabilities, the chronically ill and the frail elderly.  Unfortunately, consumers are already experiencing access problems in a majority of the areas already affected. In fact, since the January 1, 2011 implementation of this program, hundreds of consumers, patients and providers have reported problems and complaints about having access to medically-required durable medical equipment and services. We expect these complaints to increase dramatically if the program expands to an additional 91 areas across the nation.

Market Pricing Makes More Cents The Market Pricing Program Act (MPP)––or HR 6490––includes the same products that are included in the current poorly designed bidding program. The difference with MPP is that two product categories would be bid through a market auction system per geographic area and the eight additional product categories included in the current system for that same area (product categories would vary depending on the area) would have prices set by auctions conducted in comparable geographic areas.

Compared to the large competitive bidding areas used in the current system, the bid areas in HR 6490 will be smaller and more homogeneous, reflecting real markets. This is an improved program for the consumers who rely on durable medical equipment and related services and for the providers who will be able to continue to provide durable medical equipment and related services to their customers.

Consumers, physicians and clinicians all agree that the current bidding program is disrupting the continuum of care by restricting consumers from going to their providers of choice in order to receive the appropriate items and services that they need.  Enacting a market-based auction program will ensure that beneficiaries receive high-quality service and equipment that they have become accustomed to receiving and will lower health care costs.

A Show of Support Below is a current list of consumer organizations that are supporting the passage of HR 6490:

1. AAPD (American Association of People with Disabilities)

2. ADAPT, Montana

3. Ability Center of Greater Toledo

4. Association of Assistive Technology Act Programs

5. Association of Programs for Rural Independent Living

6. Association on University Centers on Disabilities

7. Brain Injury Association of America

8. Christopher and Dana Reeve Foundation

9. Disability Policy Institute

10. Disability Rights Center

11. Disability Rights Education and Defense Fund

12. Friends of Disabled Adults and Children

13. Georgia Independent Living Council

14. International Ventilator Users Network

15. National Family Caregivers Association

16. National Council on Independent Living

17. National Disability Rights Network

18. National Organization of Nurses with Disabilities (NOND)

19.Pennsylvania Statewide Council on Independent Living (PA SILC)

20. Post-Polio Health International

21.Shepherd Center

22. Spina Bifida Association of America

23.Summit Independent Living Center, Inc.

24. Three Rivers Council on Independent Living (TRCIL)

25. Touch the Future

26. United Cerebral Palsy

27. United Spinal Association