CRT Industry Seeks Technical Correction to Halt Medicare Pricing Plan

The complex rehab technology industry is now working toward obtaining a “technical correction” after the Centers for Medicare & Medicaid Services’ (CMS) rejected a bipartisan letter from Congress asking the agency to halt a plan to reimburse complex rehab wheelchair accessories at competitive bidding prices.

On April 20, a letter signed by 101 members of the U.S. House of Representatives was sent to CMS. Its goal: to ask CMS to confirm that wheelchair accessories used for complex rehab power and manual wheelchairs would continue to be paid according to existing fee schedules.

The letter was written in response to CMS’s declaration that starting Jan. 1, 2016, complex rehab wheelchair accessories would be reimbursed using prices based on the agency’s highly controversial Medicare competitive bidding program for DME.

Complex rehab technology (CRT) advocates pointed out that the 2008 Medicare Improvements for Patients & Providers Act prohibited CMS from including complex rehab wheelchairs and accessories from the national competitive bidding program.

Nonetheless, CMS responded to the letter by indicating the agency did not plan to deviate from its Jan. 1 intentions.

In a July 1 letter to members and stakeholders, Don Clayback, executive director for NCART, said, “It is extremely disappointing that CMS has said no to Congress’ formal request that CMS rescind plans to inappropriately apply competitive bid pricing to complex rehab wheelchair accessories beginning 2016. This violates the intent of 2008 federal legislation (MIPPA) and subsequent CMS policy that excluded individually configured complex rehab wheelchairs and accessories from competitive bidding.”

The potential effect on complex rehab providers and the consumers they serve, Clayback added, would be debilitating.

“This inappropriate application would eliminate access as payment rates would drop 20 percent to 50 percent, and the negative impact would extend well beyond Medicare beneficiaries to also hurt people with disabilities in Medicaid and private insurance programs,” Clayback said in his bulletin.

In response to CMS’s decision, NCART has created a position paper to alert members of Congress to the situation. “Given CMS’s refusal, Congress now needs to legislate a technical correction to clarify that CMS cannot apply competitive bid pricing to accessories used with complex rehab power and manual wheelchairs to prevent CMS’s application of these payment reductions scheduled for January 1, 2016,” Clayback said.

To download a pdf of the position paper, click HERE.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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