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Thread: Equipment providers?

  1. #11
    Do I remember reading a year or so ago that Invacare had problems with their power chairs, and they stopped selling them for awhile? Or did I dream that?
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    I am a person with mild/moderate hexaparesis (impaired movement in 4 limbs, head, & torso) caused by RRMS w/TM C7&T7 incomplete.

    "I know you think you understand what you thought I said, but what I don't think you realize is that what you heard is not what I meant."

  2. #12
    Senior Member
    Join Date
    Mar 2012
    Hampstead NC
    Chasmenger; Yes Invacare was prohibited from constructing certain products from one location and selling to excepted and already promised customers. It was (past tense) by an Order of Consent. Which at this point has been pulled back by the court system Invacare has fulfilled their obligations. They "Invacare" can now, and will sell to you, also some of the former models have been discontinued. If your vendor has cut their Invacare connection you're screwed, unless you find a different vendor! It does very much sound, from what you say, that your Medicaid department has used its yearly budget up or at least what money was assigned to your benefits.

    Stormycoon; IF you buy something for someone does you giftee have the right to upgrade your presentation and have you pay for it? That's about where you stand. Medicaid is not the exactly the same as Medicare. Your Doctor can make some demands (Write a script specifying a specific model/manufacturer) on your part, to justify your desires if he wants to. This may or may not be successful. If your local Medicaid agency is out of funds GOOD LUCK getting anything more than a picture of a Chair, that budget money is an exhaustible thing.

  3. #13
    Senior Member Stormycoon's Avatar
    Join Date
    Feb 2006
    B-vILLE Oregon
    Bob I fully qualify for new chair, the funds are there as my agent relayed. Oregon Medacaid have been using a default 5 year brand new replacement system with me?? "Fully loaded" for quadrapalegia specs.

    Just trying to assign sole proceeds to your trinity coercion here. Yes it starts w/ Doc script..Then I'll follow w/Vendor & Chair choice (Invacare)..

    Between posts though you've used a mixed power ultimatum.

    --You claimed I as patient have ultimate say of chair of my choice. Since Invacare's in good standing, that's them.
    --Vs.* Medacaid ultimatum. They pay for THEIR CHOICE of CHAIRS? (Full quote of yours at bottom)
    --Vs. Vendor's (Numotion) ultimatum.. Canceled dealer (Invacare) I'm screwed..

    ●"Medicaid pays for YOUR chair the way YOU explain it.?
    ●"But Medicaid will only pay for a chair of THEIR choice"?
    ●"But, again it sounds like your VENDOR has dropped the Invacare line, if there is a problem with the contracted supplier, you will need to get that cleared up, with Medicaid yourself"
    AKA--Consent Decree sign off which you now just said is obsolete now that they're in full compliance.

    I have had response on here from I believe an Invacare agent that if my Vendor Chair guys dropped them just call company directly & they'll get it handled..IDK who the hey would deliver & tune it ??
    Appreciate feedback. Thnxs..Again I'll get it sourced out when time comes I'm just figuring** with outlined criteria looping process, sounds as Patient has ultimate power here to get them in kahoots & chair I want..
    Last edited by Stormycoon; 07-23-2016 at 06:27 AM.
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  4. #14
    Senior Member
    Join Date
    Mar 2012
    Hampstead NC

    I am not trying to antagonize you as it appears you seem to think.
    Quote; "Between posts though you've used a mixed power ultimatum.

    --You claimed I as patient have ultimate say of chair of my choice. Since Invacare's in good standing, that's them"-----------.
    I am trying to help you sort things out and trying to provide some alternatives you can chose to use, or not.
    Yes you have the ultimate choice, if someone delivers a chair to you; you will have to sign for it, DON"T SIGN, if it is something you do not absolutely want, and have asked for. You have to be assertive, and do not compromise yourself, do not say or write anything that can be mistaken. A chair which you will spend your next five years in will be a part of you, your legs, the very essence of your environment, don't let some salesman tell you what "YOU" want.

    I your original story, you left huge gaps in your explanation. I have had to assume some things, and obviously "I" have gotten some of those assumptions wrong. There are as I said huge differences between Medicare and Medicaid Co-Insurances and Medigap stuff, etc.

    Medicaid has the same option you do, they can choose not to sign a Purchase Order that does not comply with their mandates. If your problem is finding a vendor who will get you an Invacare Chair Model whatever, ask Medicaid if they will honor your direct order to Invacare for your currently complying model (whatever) then ask Invacare; or ask first if you wish if they will sell direct on a medicaid PO. Or there are e-businesses that might help you. Since "you say" your seating needs are the same. Invacare "may" have your original PO and chair in their records. Ask if they can or will duplicate that order.

    Most of these things are usually done by your local vendor as a part of their service to attain (justify?) their markup/or commission. These things require a lot of fairly good communication skills.

    It is very likely you will likely have to put your chair together when it arrives, as you will not have a local vendor to do this for you.

  5. #15
    Senior Member
    Join Date
    May 2006
    Somewhere in the Rocky Mountains
    Quote Originally Posted by Bob Sullivan View Post

    If your local Medicaid agency is out of funds GOOD LUCK getting anything more than a picture of a Chair, that budget money is an exhaustible thing.

    Federal Law dictates that state Medicaid pay for Durable Medical Equipment/Assistive Technology if it is "medically necessary".

    This straight out of the Federal Medicaid manual for DME/Assistive Technology

    A. The Meaning of Medical NecessityThe Medicaid Act does not include a general definition of medical necessity thatapplies to all beneficiaries. The Act does make clear that, for Medicaid beneficiariesunder 21 years of age, medical necessity is established when requested health care,diagnostic services, treatment, or other measures are required "to correct or amelioratedefects and physical and mental illnesses and conditions . . .?92 This means that forchildren and youth, Medicaid services must be provided if needed to correct, tocompensate for, or to improve a condition, or to prevent a condition from worsening.93In the absence of a federal medical necessity definition for adult beneficiaries,some states define this term to require that the requested Medicaid service beappropriate for the beneficiary?s medical condition or disability and that provision of theservice be consistent with accepted standards of medical practice. Some states alsorecognize that services may be medically necessary if they will ?prevent? illnesses orinjuries.94 A state's medical necessity definition may be found in state statute, rule,policy, or the agency's provider manuals.

    B. AT and Other Medicaid Benefit CategoriesIn some cases, a requested AT device may not meet the state's DME definitionor the beneficiary may not be eligible for home health services. In those instances,there may be a more appropriate benefit category for establishing Medicaid coverage ofthe necessary AT item. Given the broad scope of Medicaid’s required and optionalcategories of service, an AT device may fit within one or more benefit categories foundin the Medicaid state plan.58 As discussed above, physical therapy, occupationaltherapy, and speech therapy, which by definition include necessary equipment,prosthetics, preventative services, and rehabilitative services are categories of servicethat may also allow for coverage of particular AT devices.Keep in mind that states cannot characterize an AT device as belonging in onecategory of service, to the exclusion of all others, in an attempt to limit the scope ofcoverage. For example, a state cannot solely cover speech generating devices (SGDs)under the optional category of speech language pathology services in order to limit theiravailability to children, when SGDs also satisfy the state's definitions of DME, prostheticdevice, or other benefit category included in the state plan.59 This approach has beenused by some states to restrict access to certain AT devices to HCBS waiverparticipants. However, CMS has been clear that this type of restriction isunacceptable.60
    It has nothing to do with whether a state has "Medicaid Funds".

    States are free to provide optional benefits if they want but an electric wheelchair or any other kind of wheelchair (defined as "Assistive Technology" is not optional based on whether a state has funds or not.

    Your state is free to administer the program however it sees fit which includes the majority of benefits that are not optional to provide. Medicaid is Federal and if it is medically necessary then the patient get's the equipment.

    I am not sure where you acquired this information but it is erroneous at best.

    With that kind of thinking, there would be many people sitting on the curbs having been thrown out of nursing homes and hospitals because their care cost to much and funds were exhausted. Please do some research.

    I am sure the state funds are calculated via data mining in what they know about an individual patient and maybe funds are allocated for each patient yearly based on what they may or may not need BUT ultimately you should not be told that the state is out of funds if you really need a wheelchair.

    The above is a very good read for all of us as it contains specific court cases. There are law firms around the country that will help you appeal a Medicaid Medical Necessity decision. I belong to an organization that takes on these kinds of issues.
    Last edited by darkeyed_daisy; 07-23-2016 at 04:24 PM.
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  6. #16
    Senior Member
    Join Date
    Mar 2012
    Hampstead NC
    Darkeyed daisy; No place does any law or rule say--"promptly?--So that is why, the GOOD LUCK wishes. Stormy coon"s original question was; "United seating & Mobility is now Numotion. Who else is available that does this same thing of getting chairs to folks..? They completely cut Invacare chairs out of their product supply ordering & that's the chair I like & use.. Has anone had similar issues of having to change chair vendors or whatnot.?"

    The conversation has migrated to figuring out why Medicaid has made, what appear to be excuses for attending to his needs. I have made some suggestions why he has had this problem, and how to circumvent them. We all have problems enough without having to battle vendors about the MFG/ of the chair he seems to want. Or if the vendor wants to carry that brand.

  7. #17
    Medicaid in Oregon is administered via the CCO in your area. That should be your first port of call (I presume that's with whom you spoke already). It's not one monolithic organization as in some states.

    Even if you have no choice of DME (an assumption I would verify, since in many areas there are still small providers out there, who would be willing to drive for a bit to pick up a complex rehab chair order), Invacare and Numotion, if that is with whom you must deal, can work together to get you a chair. Your and your clinician's job is to make that seem like a desirable course of action/the path of least resistance.

    Therefore, your clinician's order should include an open box narrative explaining why only Invacare chair X will work for you, given conditions X, Y and Z and past history w/ whatever chair(s) you have had or tried. You should be able to get a case manager at your region's CCO who can expedite the order once the DME places it. No one wants to see a headline about the SCI pt screwed over by the State. With polite persistence, you can ensure that your clinician can document your need for specific equipment to perform mobility-related ADLs.

    As for the hefty service call you had recently, if it related to the overall status of the chair, that can be funneled into a narrative about the cost-effectiveness of a new chair, documented properly. The Medicaid contact's "advice" relates more to her budgets than any actual likelihood of disallowing a chair order that demonstrably meets medical necessity guidelines, insofar as you communicate, always with persistent politeness, that you would not take that denial quietly and go away.

    All this assumes that your current chair is not a viable option for long, full stop, and that Invacare chair X can be documented as the best replacement. There has to be a true story for evidence to win the day in a case like this.

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