[Congressional Record Volume 154, Number 69 (Tuesday, April 29, 2008)]
[Senate]
[Page S3510]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Ms. Stabenow, and Mr. Johnson):
  S. 2931. A bill to amend title XVIII of the Social Security Act to 
exempt complex rehabilitation products and assistive technology 
products from the Medicare competitive acquisition program; to the 
Committee on Finance.
  Ms. SNOWE. Mr. President, I rise to introduce the Medicare Access to 
Complex Rehabilitation and Assistive Technology Act of 2008. I am 
pleased to be joined by my colleague from Michigan, Senator Stabenow. 
Today, we unite to ensure access to medical equipment for severely 
disabled Medicare beneficiaries who seek to lead independent and 
productive lives.
  In the 2003 Medicare Modernization Act, MMA, Congress directed the 
Centers for Medicare and Medicaid Services to proceed with a durable 
medical equipment competitive bidding demonstration project. The 
purpose of this demonstration was to determine whether competitive 
bidding can be used to provide quality medical equipment at prices 
below current Medicare Part B reimbursement rates. The bidding will 
result in a new fee schedule for some selected DME services, replacing 
Medicare's current fee schedule. In other words, competitive bidding 
will change how Medicare covers medical equipment and also determine 
which suppliers may participate in providing such equipment to 
beneficiaries.
  It is critical to note that the Medicare competitive bidding program 
was designed to produce cost savings--both for Medicare and for 
beneficiaries in the form of lower copayments for medical equipment. 
The competitive process of submitting bids to supply particular 
services and products would reduce the price Medicare currently 
reimburses for these items.
  Although competitive bidding may reduce the cost of some health 
services, this system will likely prove unworkable in certain 
circumstances. For example, many rural areas across the country may not 
have the health care infrastructure to support a competitive 
acquisition program. Small suppliers who service individuals residing 
in areas of low population density may be outbid by larger, distant 
providers, leading to limited access to medical equipment for Medicare 
beneficiaries living in these locations.
  Another unique circumstance for which competitive bidding is 
inappropriate regards complex rehabilitation and assistive technology 
for individuals with significant and distinctive needs. Under the 
competitive acquisition program, thousands of individuals who require 
customized medical equipment may be forced to use ill-fitting products 
that will inevitably increase discomfort, further limit functional 
ability, and may even cause loss of function for these individuals who 
seek independence and mobility in their lives.
  Let me give an example of how the competitive bidding program will 
hamper the ability of Medicare beneficiaries to access necessary 
rehabilitative and assistive technology. If a Medicare beneficiary has 
been diagnosed with muscular dystrophy and uses a power wheelchair due 
to the loss of muscle tone in the body, a wheelchair that is tailored 
to the individual is imperative for several reasons. Power wheelchairs 
that are not adapted to the particular needs of the individual lead to 
more than mere discomfort, but also can further worsening health. For 
instance, individuals with muscular dystrophy may have wheelchairs that 
allow them to change positioning in order to breathe more comfortably. 
In addition, these wheelchairs may also be adapted to accommodate other 
necessary medical equipment, such as breathing ventilators. Yet with 
Medicare competitive bidding, the process will likely yield more 
uniform wheelchairs, leaving severely impaired beneficiaries with 
limited options to meet their needs.
  Our bill will remove complex rehabilitation and assistive technology 
products from the Medicare competitive bidding program. In a program 
intended to reduce costs through competition among suppliers providing 
medical products, it is simply untenable to include such sophisticated 
and personalized equipment. We all agree that we must address Medicare 
spending, but restricting access to necessary products for the 
beneficiaries that most require them is not the way to approach this 
issue--and may in fact increase costs.
  I urge my colleagues to join with Senator Stabenow and myself in 
supporting the Medicare Access to Complex Rehabilitation and Assistive 
Technology Act of 2008 to support Medicare beneficiaries in receiving 
the specialized medical equipment they so critically need.
  Ms. STABENOW. Mr. President, I am pleased to join my colleague, 
Senator Olympia Snowe, in introducing the Medicare Access to Complex 
Rehabilitation and Assistive Technology Act. This legislation will 
ensure Medicare beneficiaries who need complex rehabilitation and 
assistive technology will continue to receive the highest level of 
service and support necessary to maintain their independence. I am also 
pleased to be joined by my good friend, Senator Tim Johnson, in this 
effort.
  Competitive bidding, while well-intentioned, does not work well for 
items that must be customized for individuals with complex and 
specialized needs. Unlike some of the items being considered by CMS for 
competitive bidding, complex rehab technologies are not the sort of 
products that are easily interchangeable. For example, individuals with 
neuromuscular diseases--such as multiple sclerosis, ALS, cerebral 
palsy, or Parkinson's disease--or conditions such as spinal cord 
injuries may require specialized services because of the profound and 
sometimes progressive nature of these conditions. Patients' access to 
assistive technology products for their unique needs could be in 
jeopardy.
  I am pleased that our legislation has the support of numerous patient 
advocacy organizations. As co-chair of the Senate Parkinson's Caucus, I 
have seen firsthand how assistive technology can make a difference in 
helping a loved one achieve independence over a disease or disability. 
The legislation we are introducing today will ensure that the wonders 
of medical technology will continue to be available to the Medicare 
beneficiaries who need them the most.
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