CMS to Use Competitive Bidding Prices to Set CRT Accessory Allowables
Medicare’s national competitive bidding program has once again encroached on complex rehab technology (CRT).
In a Feb. 4 bulletin to members and stakeholders, Don Clayback, executive director of NCART, said the Centers for Medicare & Medicaid Services (CMS) intends to use competitive bidding pricing to set allowables for CRT wheelchair accessories. Competitive bidding information would come from bids for standard wheelchair accessories.
Clayback explained that November final rule CMS 1614-F — about how pricing gleaned from competitive bidding would be used to set DME pricing in areas not under competitive bidding — left out key information about CRT, and that NCART therefore “followed up with CMS in writing and in person.”
Clayback said, “We received some very disturbing answers in a Frequently Asked Questions published by CMS in December. The FAQ indicates that effective Jan. 1, 2016, CMS intends to use competitive bidding pricing information obtained from bids for standard wheelchair accessories to reduce the payment amounts for complex rehab wheelchair accessories. If this policy is not rescinded, effective Jan. 1, 2016, when these codes are used on complex rehab wheelchairs, they will be paid at lower competitive bidding-determined payment amounts instead of the traditional fee schedule amounts under the current policy.”
Such pricing would reduce access CRT consumers’ access to the technology they need to meet clinical and functional needs, Clayback said. He added that CMS’s latest pricing plan directly violates the 2008 Medicare Improvements for Patients & Providers Act, “which specifically exempted wheelchair accessories used with complex rehab power wheelchairs from the competitive bidding program. It also goes against subsequent Medicare policy developed following the legislation, which provides the same payment policy for wheelchair accessories used with complex rehab manual wheelchairs.”
At press time, Clayback said CMS had not released an official list of impacted CRT codes. But he emphasized CMS’s plans should be rescinded based on the following:
- It’s in violation of Congressional legislation (MIPPA 2008).
- It’s contrary to subsequently developed Medicare policies created by CMS following the legislation that provides for accessories used on both complex rehab manual and power wheelchairs to be paid at traditional fee schedule amounts.
- It’s using information obtained through competitive bidding that relates to standard wheelchair accessories and inappropriately applying it to complex rehab wheelchair accessories that were not part of competitive bidding.
- Since many other payors follow Medicare policies, the fallout will also impact access for people with disabilities who are covered by Medicaid and other health insurance plans.
Clayback said NCART will continue to communicate with CMS directly, but has also asked members of Congress to intervene.
This article originally appeared in the March 2015 Mobility Management issue of Mobility Management.