Source: ACB – http://acb.org/LILVdevice

Legislative Imperative

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 lenses 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.

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 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 pre-emptive and unwarranted coverage denial for any new technology designed to assist individuals with vision loss.

ACB believes that this pre-emptive 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 coverage exclusion for low-vision aids, we will undoubtedly see a decrease in innovation in this area.

Legislative Proposal

ACB urges the House of Representatives to promptly pass H.R. 729, the Medicare Demonstration of Coverage for Low Vision Devices Act of 2015.

This legislation would evaluate, through a five-year national demonstration project administered by the Department of Health and Human Services, the fiscal impact of a permanent change to the Social Security Act. This legislation would allow reimbursement for certain low-vision devices that are the most function-rich, most powerful, and most expensive. The devices would be considered durable medical equipment.

Individuals will be eligible to participate in the demonstration project only after completing a clinical evaluation performed by an ophthalmologist or optometrist who would then deem a low-vision device as medically necessary.

The national demonstration project is designed to provide a rich, well-structured and defined data set that can yield Medicare-program-wide evidence-based conclusions using appropriate statistical methods.