All:

 

Your help needed please!!  Lew Golkinger is requesting information from those working with ALS and AAC.  Please respond directly to Lew at xxxxxx@aol.com

 

Lew’s email:

 

In June, the Medicare program, administered by the Centers for Medicare and Medicaid Services (CMS) proposed a complete overhaul of how SGDs are paid by Medicare.  Since the first SGD purchase by Medicare in the 1980's and continuing through the 12 years since the current guidelines have been in place, Medicare has purchased SGDs with full payment following device delivery to its user.  CMS now proposes to pay for all SGDs on a rental basis, which Medicare calls "capped rental."  This payment method provides 10 % of the full amount for 3 months, followed by 7 1/2 % of the full amount for the next 10 months.  After continuous rental for 13 months, the client owns the device.  If the rental period extends the full 13 months, the supplier receives 105% of the full price.  CMS wants to make this change because it believes it will save a lot of money.

 

CMS says there will be no change to the access rules for any affected equipment, so anyone eligible before the change will be eligible after.  And, continued access will be allowed as long as medical needs continue, so there will be no harm to clients.  On the other hand, if someone does not use the device on a continuous basis for 13 months, Medicare says it shouldn't be paying for devices not being used. 

 

PALS are the only condition for which a 13 month rental might conceivably overlap with client death. (Everyone else has a stable, chronic need that will continue for life and life expectancy is not within a 13 month window.)

I'm interested in any data that may exist regarding how long people with ALS live after getting an SGD.  I don't need names, and I don't need studies.  Just data

Same with use of NF care or hospice care.  Rental DME will not cross those thresholds.  So, even though PALS communication needs won't change in those settings, they won't have a device.

Also, rates of hospitalization for PALS -- hospitals are yet another place DME isn't accessible.

I have until the end of August to respond to CMS.  Any help you can provide directly or by referral to others will be appreciated. Answers needed:

 

1) how long do people with ALS survive after receipt of an SGD? 

2) what percentage of people with ALS enter nursing facilities?

3) what percentage of people with ALS receive hospice services either facility based or at home?

4) what percentage of people with ALS receive multi-day in patient hospital care with or without post discharge rehabilitation center placement?

 

If data already have been gathered and these statistics exist for PALS nationally; or within a single center, clinic, or other facility or practice; great.  If they can only be extracted from individual records, is it possible to do so quickly for patients served in the past year?

 

 

Alisa

 

Alisa Brownlee, ATP

Assistive Technology Specialist

ALS (Lou Gehrig’s Disease) Association, National Office and Greater Philadelphia Chapter

Conference Chair, RESNA 2014 Convention

215-631-1877

 

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Mark you calendars!

RESNA’s 2014 Conference is “Racing Towards Excellence in Assistive Technology”

June 11-15, 2014—JW Marriott Indianapolis, IN

http://www.resna.org