Independent Living Research

RESEARCH INFORMATION ON INDEPENDENT LIVING
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Volume 2, Issue 4

Durable Medical Equipment

Durable medical equipment, defined by Medicare, is doctor-ordered, reusable medical items for use in the home. According to Medicare, these items typically last for years contrasted with consumable medical supplies such as diapers.

Examples of durable medical equipment include canes, crutches, walkers, wheelchairs, scooters, hospital beds, oxygen tanks, aspirators, commode chairs, blood glucose monitors, ventilators, suction pumps, and seat lift mechanisms. Prosthetic devices such as artificial limbs and orthotic items (for example, neck or leg braces) also qualify.

Items not in this listing may be covered if they meet Medicare’s “reasonable” requirement test, which is:

Would the item expense be worth the therapeutic benefits?
Is the item substantially more expensive than a different method of care?
Does the item serve the same purpose as equipment the person already uses?

The most common denials, even with a physician’s “Certificate of Medical Necessity,” are oxygen equipment and hospital beds. Some items that Medicare doesn’t cover are exercise equipment, ramps, stair lifts, surgical stockings, wigs, bath aids, hearing aids, and air conditioners. Residents who live in skilled nursing facilities also are not eligible for Medicare Part B durable equipment.

Equipment can be obtained from a Durable Medical Equipment Regional Carrier (DMERC), a private company that contracts with Medicare to pay bills for durable medical equipment. Its staff deliver and install products. They also instruct patients about product use.

Durable medical equipment may be bought or rented. Medicare pays for its use only in the patient's own home, which also could be considered a relative's home or foster care.

Since 1989, home health care expenses have experienced a 20% annual growth rate. Growth can be attributed to shorter hospital stays, technology developments, and increased availability. The top products distributed include: wheelchairs (62%), hospital beds (57%), oxygen concentrators (55%), and incontinence supplies (50%).

A recent change has been the Medicare Modernization and Prescription Drug Act of 2002. This legislation added competitive bidding to Medicare purchases of durable medical equipment, prosthetics, orthotics, and supplies. This “lowest bidder wins” change replaced the previous fee schedule.

Some disability advocates think the move will result in discontinued product lines, delays, fewer custom fittings, and equipment company monopolies.

Andrew Imparato, disability activist with American Association of People with Disabilities, said Medicare should be changed to offer more choices, not fewer, for people to live more independently in their own communities. He encouraged Medicare users to contact their government representatives about the competitive bidding proposed change.

Besides Medicare and Medicaid, consumers may get free or discounted necessary equipment from a comprehensive rehabilitation program, state agency, local affiliate of a non-profit disability organization, or volunteer groups.

It is illegal if a supplier offers to drop co-payments or deductibles or offers discounts, coupons, or rebates to bypass the Medicare co-payment requirement. Avoid buying equipment from suppliers that:

Do not have local service or maintenance offices to avoid delayed service and long-distance phone calls.
Use high-pressure sales tactics.
Offer equipment at no charge.
Say they are Medicare representatives because Medicare doesn’t have involvement with equipment sales or rental.

Cindy Higgins, The Research and Training Center on Independent Living, The University of Kansas, 1000 Sunnyside Ave., Room 4089 Dole Center, Lawrence, KS 66045-7555, (785) 864-4095, E-mail: [email protected]. This project is funded by the National Institute on Disability Rehabilitation Research grant #H133A980048.

Information for this review came from the interactive Research Information on Independent Living (RIIL) database at www.GetRiil.org, which contains research summaries related to independent living with disabilities. A special effort has been made to include information that independent leaders in the field said they wanted, namely topics regarding accessible, affordable housing, effective advocacy for rural areas, effective transition from schools and nursing homes, accessible, affordable transportation, reaching underserved populations, policies that impede independent living, rural health care services, and Medicaid/Medicare regulations for durable equipment.

RIIL is a joint effort of the Research and Training Center on Independent Living at the University of Kansas and the Independent Living Research Utilization (ILRU) Program of TIRR