Use it or Lose it: The Medicare Low Vision Demonstration Project

Abstract

The Low Vision Demonstration Project is now one year old. This project constitutes a unique and pivotal opportunity for vision rehabilitation professionals. If it succeeds, it will open up significant opportunities for funding and provision of services. But, if it fails, it could represent another nail in the coffin of specialized services. The question now is whether professionals in the field of visual impairment and blindness will step up to the plate to ensure that this project is successful. The achievements of the project have been encouraging so far, but there are a number of significant weaknesses, and there is still much to do. This column offers a progress report on the project and examines its serious implications. Although some reports have appeared in previous issues of the Journal of Visual Impairment & Blindness (JVIB) (see, for example, the Comment entitled Medicare Coverage for Orientation and Mobility Services, by Lorraine Lidoff, which appeared in October 2005; and the special report that appeared in the From the Field department of the August 2006 issue), let me first provide an overview of the project for anyone who is not familiar with it. SCOPE OF THE PROJECT Begun on April 1, 2006, the Low Vision Demonstration Project is a five-year project established to help deliver services in a new manner and evaluate the utilization of funding for vision rehabilitation services by a new set of providers who had not previously been covered by Medicare: certified low vision therapists, orientation and mobility (OM however, the demonstration project also covers vision rehabilitation training that may be provided in the eye care specialist's office or at a qualified agency. Because the project is funded by Medicare, service providers are obliged to follow its requirements, which may differ from customary procedures in vision rehabilitation. Specifically, all services must be preceded by a written plan of care, with specific goals and a statement of the location at which the services are to be provided, which must be approved by the supervisory physician and reviewed every 30 days. The service provider must detail the training provided and the progress made by the patient. Training is limited to nine hours total, to be provided within 90 consecutive days, and cannot be extended. Vision rehabilitation services are billed in 15-minute increments. For this demonstration project, six different sites in four states and two cities throughout the United States have been selected: Atlanta, Georgia; Kansas; New Hampshire; the five boroughs of New York, New York; North Carolina; and Washington State. The patient must reside in one of these six areas, and the supervising eye care specialist must have his or her practice in one of the six sites. The patient must have a corrected visual acuity in his or her best eye of 20/70 or worse, or have a documented central scotoma, a general constriction of the visual fields, or bilateral hemianopia. Qualifying patients must show a medical necessity for the services rendered, be capable of progress, and be able to derive a benefit. …