Rep. Lee Zeldin (R-N.Y.) has introduced H.R. 3229 into the U.S. House of Representatives to stop a Medicare plan to apply competitive bidding prices to complex rehab technology (CRT) wheelchair accessories.
The new bill is in response to Centers for Medicare & Medicaid Services’ (CMS) intention to use Medicare competitive bidding prices to pay for accessories used on CRT wheelchairs starting Jan. 1. More than 100 members of the House signed a bipartisan letter in April that stated that the 2008 Medicare Improvement for Patients & Providers Act (MIPPA) excluded CRT from the competitive bidding program.
When CMS in June declined to alter course despite the letter, CRT stakeholders sought a “technical correction” to close language loopholes in MIPPA that are enabling CMS to change CRT accessory allowables – a move that would imperil beneficiary access to this critical equipment.
A Straightforward & Simple Bill
While H.R. 3229 is a bill, it significantly differs from other current industry bills — such as H.R. 1516, which seeks to establish a separate Medicare benefit category for CRT – in its scope and simplicity, says Don Clayback, executive director of NCART.
“It’s a pretty straightforward and simple bill, and we’re happy to get it introduced and look forward to getting it passed,” Clayback told Mobility Management.
Although the letter from Congress failed to sway CMS, Clayback said industry advocates are still talking to CMS in hopes of getting the agency to change its plans. But with new accessory pricing on CMS’s calendar for January, Clayback said the industry had to try another tack as well.
“Unfortunately, given the timing, we had to pursue a legislative route and get ‘technical correction’ language introduced that clarifies the legislation that was passed in 2008,” he noted. “The intent [of MIPPA] certainly was that competitive bidding pricing should not be applied to complex rehab wheelchairs and accessories.
“There’s the two routes that we knew at the start: the regulatory route, which is really the preferred route, or the legislative route. We’ve been working on the regulatory route: We got the letter from the House in April, and then we got the CMS response in June.”
While all this is going on, Clayback said the industry is working toward a second letter to CMS, this time from the Senate, to urge the agency to reverse its decision.
“But on the legislative side,” Clayback said, “we needed to get something in place that would provide this technical correction.”
Access to CRT Wheelchair Accessories in Danger
H.R. 3229 is indeed brief, especially compared to typical bills. It seeks to delete a conjunction in one clause, add a conjunction to another clause, and to add a short paragraph that states that CRT wheelchairs and accessories provided on or after Jan. 1, 2016, will not have its Medicare reimbursement fees determined by payment amounts derived from Medicare’s competitive bidding program.
If CMS succeeds in implementing its pricing plan in January, reimbursement for 171 HCPCS wheelchair accessory codes would fall 20 to 50 percent, according to NCART analysis.
Impacted products range from ventilator trays for wheelchairs to powered seating options such as tilt and recline, to manual wheelchair tires and caster forks.
Because H.R. 3229 is basically a clarification of existing law rather than brand-new legislation, Clayback is hopeful that support will come swiftly.
“The advantage that we have is it’s very simple and straightforward language,” he says. “Literally, the actual language is one sentence that needs to be modified. And the fact that we had 101 House members sign on to the issue in the letter to CMS is I think a good indication that it’s got a good level of support within the House of Representatives.”
The new bill may have gotten a boost thanks to a July 20 display of CRT products in the Rayburn House Office Building. On that afternoon, CRT manufacturers and supporters were on hand to demonstrate CRT and explain exactly how it differs from off-the-shelf DME.
“We had met with Congressman Zeldin as a follow-up to that the next day,” Clayback says. “The expo definitely heightened the awareness of CRT, but also on the issues in play. We now have a bill that when members say, ‘What is the fix that you need?’, we can point to the language in the bill. It’s a technical correction versus comprehensive legislation. It really is a straightforward, easy-to-understand message. When they see it in black and white, it helps validate that.”
Action points for CRT providers, manufacturers, advocates and consumers, Clayback says, include urging members of Congress to sign onto H.R. 3229, as well as support the upcoming Senate letter to CMS.
