From Stillwater-Ponca City (OK) Ostomy Outlook Apr 2004:

Advocacy Report Card for 2003

by Linda Aukett, Chair, UOA Government Affairs Committee; distributed by e-mail, Feb 14, 2004


The UOA Government Affairs Committee has a mixed report for 2003, some good news for 2004, and continues to need YOUR help.

2003 saw another round of changes to the Medicare reimbursement structure, with a number of new codes and fees introduced in April 1st. The changes were mostly positive, with fee increases outweighing decreases 3 to 1. Compared with fees in 2001, fee increases ranged from 5% to 153% (with an average of 35%), while the small number of decreases ranged from 4% to 7% (averaging 6%). We hope that more dealers found they were able to accept Medicare assignment in the rest of 2003 and now, thus helping to reduce the net expense to beneficiaries.

As we enter 2004, we are able to report that some additional fee increases have gone into effect for a few of the categories that were not updated in April 2003:

  • 2 Pc drainable pouch (A5063) fee increases to $2.70 per pouch.
  • 2 Pc drainable pouch w/locking flange (A4426) fee increases to $2.73 per pouch.
  • 2 Pc drainable pouch w/locking flange & filter (A4227) fee set at $2.78 per pouch.
  • 2 Pc closed pouch w/locking flange and filter (A4423) fee set at $1.86 per pouch.

The last two had originally been reimbursed on an "individual consideration" basis but now have one national fee.

Passage of the Medicare Reform Act in late 2003 contained some good news for our members (prescription drug coverage) as well as a significant challenge. For the next five years, the current fees paid by Medicare will be frozen at the 2003 level. Beginning in 2007, a totally new system will go into effect, mandating both HOW MUCH is paid, and WHO will provide ostomy supplies to Medicare beneficiaries. The system is called "competitive bidding" and will be applied to all kinds of durable medical equipment (DME). Dealers that win the bidding competition will be the ONLY ones to whom a Medicare beneficiary can go for their medical equipment needs (and it may be a different dealer for each type of DME).

Initially the system will apply only in the 10 largest metropolitan areas (for example, one of these areas is the "Metropolitan Statistical Area" that includes Philadelphia, PA, Wilmington, DE and Atlantic City, NJ, and all the communities in between). However, if Medicare officials find they can significantly lower what they pay for certain items through the bidding process, they are authorized to apply that same lower fee anywhere in the US.

UOA asked for the help of our members when we were trying to convince Congress that competitive bidding would impose too much of a burden on our older members. Happily a number of UOA members and others did communicate this message, including over 200 who attended the UOA Annual Conference in Las Vegas. We believe that was partly responsible for the delayed timeframe for implementing the bidding system. THANK YOU!! The delay gives us more time to make a strong case that ostomy supplies should be exempt. We will continue to ask our members to help us educate Congress about the negative consequences of their actions, so please stay tuned.

MEDICAID - State funded health care for the poor:
As healthcare and security costs rise, states face serious budget challenges over how to provide medical care to low income disabled people, seniors and families. In 2003 UOA was called on to face threats to ostomy supply coverage for these groups in California, Oregon, and New York, and the committee has begun to watch developments closely in all 50 states.

We are grateful to the many California citizens who answered our call in 2003, who wrote to their legislators and attended a California Senate hearing. We're glad to say that so far ostomy supplies are still available through Medi-Cal, and with the help of our many activists in that state, it will continue to be the case.

One specific challenge to Medicaid coverage of supplies in 2004 will be in Massachusetts. The Medicaid administrators there initially proposed across-the-board cut as of 1/1/04 -- they have since backed off a little, but we anticipate continued efforts to control overall spending by limiting access to ostomy supplies and other items. In California, last year's proposed 5% cut is held off by a judicial order, but the state has vowed to appeal, and wants to cut payment by an additional 10% this year. This will push dealers to drop many lines of products, as similar experience in Florida has shown.

We really need advocates in every state who will stand up for those poor, disabled and elderly who don't have the resources or energy to speak for themselves. At its root, that's what advocacy is -- providing a voice.

Connecticut remains the only state with a mandate for coverage of ostomy supplies for persons who have non-Medicare health insurance. We are happy to report that a bill has been introduced in Massachusetts that would obtain the same mandate, and similar work goes forward in Florida. An Arizona legislator has recently promised to introduce similar legislation in that state.

Without such legislation, insurance firms such as United Healthcare can continue with impunity to deny coverage for ostomy supplies, within the "fully-insured" plans they offer to employers.

Bowing in part to pressure from UOA, United Healthcare has made a gesture--however limited--to help people in "fully-insured" plans obtain the ostomy and other medical supplies they need. Although few details have been made available to their customers since it was announced in August 2003, they indicate they have both a special rider that employers may purchase, or the covered employees can obtain discounted supplies through a special program they operate, using one identified provider.

In December, UOA initiated a contract with Netscan iPublishing for their LegAlert services. This service scans the legislative activity of the federal government and all states, and will alert the Government Affairs Committee when any of several keywords are mentioned. An initial survey found insurance-coverage related bills in 3 states that had been previously unknown to us, so follow-up will certainly occur in those states as well as in others where legislation is introduced that would impact people with a stoma or their rights or reimbursement. Agreement to a 2-year contract allowed us to negotiate a very reasonable annual fee.

This investment will be most effective when we are able to identify more UOA members that are willing to be called upon to help at their state or Congressional level as issues are identified. The easiest way is for members who have an email address to sign up for the Advocacy E-list at On that site, look at the very bottom of the "home" tab for the box saying, "Join our Action E-list". Once you have done that, we can communicate with you when we need you to share your voice on an issue, update you about new resources or inform you of other developments.

Here's a recent example: The LegAlert system told us about a bill introduced into the Maryland legislature that would require businesses without a public restroom to make their private facilities available to someone with a medical need - such as someone with IBD or with an ostomy. We have been able to find only 6 Maryland residents on the E-list, and have provided them with the details of a scheduled committee hearing and how they can get more involved in supporting the bill. Yet Maryland has nearly 500 UOA members, so it's certain there are more than 6 there who could help us, if they would only identify themselves to us as willing.

In the past year, UOA's advocates sent a total of 1,029 messages to Congress and others on topics of interest to UOA and its members. Most were sent by e-mail, but some people printed their letters to fax or mail. One chapter leader uses the Capwiz Media Guide to communicate with local papers about their upcoming meeting programs - NOTE this resource is available to ALL chapters at

Further, three chapters with their own website have used our "web sticker", which directs their site visitors to the UOA Advocacy page to send Congressional messages. That has helped extend our reach a lot in the Boston area, Oklahoma, and New Jersey. Chapter webmasters or any UOA member can obtain the necessary codes for adding this to their own site, at

Last spring, UOA members took part in two events in Washington, DC, both aimed at increasing the funds for two federal agencies:

  • The National Institutes of Health for research into diseases that lead to ostomy;
  • The Centers for Disease Control & Prevention, for activities to promote colon cancer screening.

Nine members attended the Public Policy Forum of the Digestive Disease National Coalition March 23-24, and 3 members attended the lobbying effort of "One Voice Against Cancer" April 7-8. Team visits were made to Congressional offices to educate Congressmen about the value of research. These visits helped convince Congress to continue a generous level of funding for critical research activities.

Our collaborative efforts with the Wound Ostomy and Continence Nurses Society must also be mentioned. Individually and as an organization, the WOCN has been most helpful with many of our efforts to improve the lives of people who live with a stoma or continent diversion. Several WOCN members are registered on the Action E-list, so will see this report. We thank you very much!

If you have a question about your reimbursement situation, or some other advocacy need, call the UOA office at 800-826-0826 and ask to be put in touch with the Advocacy Hotline, or e-mail advocacy[at] You have already indicated you are willing to help, so please bookmark the Advocacy Page ( and check it often. Use the "pass-the-word" function to let others know where they too can get details about UOA's advocacy issues.

In conclusion, thank you very much for sharing your time and your voice to help others with a stoma!

Linda Aukett,
Chair, UOA Government Affairs Committee
LeAnna Geurin, Member
Keith Carlson, Member
Vince Puma, Member

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Content last revised 2004-04-05