[oregon-l] Another Legislative Imperative

[Kae Seth]

In the lead up to the 2011 Legislative Seminar, below is the background
paper for ACB's legislative imperative regarding Medicare's exclusion of
coverage for low vision devices.





Eric





                        American Council of the Blind


____________________________________________________



                                    2200 Wilson Blvd., Suite 650 .
Arlington, VA 22201 . Tel: (202) 467-5081 . Fax: (703) 465-5085








Low Vision Aid Exclusion

Legislative Imperative

2011 ACB Legislative Seminar



Background



In November of 2008, the Centers for Medicare and Medicaid Services (CMS)
promulgated a regulation that has had a detrimental impact on the lives of
countless individuals who are blind or visually impaired.



To the dismay of the blind community, the Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Acquisition Rule
contains a provision entitled "Low Vision Aid Exclusion" which states that
all devices, "irrespective of their size, form, or technological features
that use one or more lens to aid vision or provide magnification of images
for impaired vision" are excluded from Medicare coverage based on the
statutory "eyeglass" exclusion. ACB is well aware that this extremely
restrictive reading of the "eyeglass" exclusion has resulted in the denial
of vital assistive devices for seniors and other Medicare beneficiaries who
may have disabilities, particularly those with vision loss, who need to use
such devices to live healthy, safe and independent lives.



Impact of the Exclusion



This proposal has had a significant impact on beneficiaries with vision
impairments who depend on assistive technology that incorporates "one or
more lens" to aid in their vision. The expansion of the eyeglass exclusion
has prevented access to devices such as hand-held magnifiers, video
monitors, and other technologies that utilize lenses to enhance vision.
These tools are often essential for individuals with low vision who, without
the aid of assistive technology, cannot read prescriptions, medicine
bottles, and other important materials containing content that is vital to
their personal health and safety. Unbelievably, CMS has also excluded
coverage of inexpensive devices like white canes.



In short, these devices allow individuals with low vision to live
independently and safely and to perform activities of daily living.



Without the aid of such assistive devices, many more individuals will be
forced into care facilities and nursing homes as our population ages.
Seniors on fixed incomes often find the cost of such devices burdensome and
therefore are unlikely to be able to afford to purchase them on their own.



The initial impact of this unreasonably narrow interpretation of the
eyeglass exclusion has meant a decrease in access to current devices, since
prior to this rule change, it was not uncommon for Administrative Law Judges
to require Medicare to provide them to beneficiaries who had visual
impairments and could demonstrate the requisite necessity. We believe the
proposal will have an even more detrimental impact in the long-term. The
expansion of the statutory eyeglass exclusion to include any technology that
uses "one or more lens for the primary purpose of aiding vision," serves as
a preemptive and unwarranted coverage denial for any new technology designed
to assist individuals with vision loss.



ACB believes that this preemptive coverage denial is particularly harmful
because it serves as a tremendous disincentive to innovators and researchers
to develop new and progressive vision technology. Medicare coverage policies
often drive the coverage policies of private health plans, which are
influential when it comes to investments in research and development. If
Medicare continues to maintain this preemptive coverage exclusion for low
vision aids, we will undoubtedly see a decrease in innovation in this area.



Recommendation



ACB calls on the U.S. House of Representatives and Senate to introduce and
pass  the Low Vision Devices Inclusion Act of 2011. This critical
legislation would overturn the CMS regulation barring coverage for low
vision devices and establish criteria for their provision. Such criteria
would acknowledge other distinctive features employed by the most valuable
low vision devices, other than their mere use of a lens, such as a device's
integration of a light source, use of electrical power, or other distinctive
features.



For further information, contact

Eric Bridges

Director of Advocacy and Governmental Affairs

American Council of the Blind

2200 Wilson Boulevard, Suite 650

Arlington, VA 22201

ebridges at acb.org