Medicare allowables for accessories used on complex rehab technology (CRT) power wheelchair won’t be based on pricing derived from the Centers for Medicare & Medicaid Services (CMS) competitive bidding program, the agency has announced.
In a June 23 bulletin, CMS said it “is issuing a new policy on how adjustments to the fee schedule based on information from competitive bidding programs apply to wheelchair accessories and back and seat cushions used with Group 3 complex rehabilitative power wheelchairs.” Those adjustments will no longer happen, so starting July 1, “payment for these items will be based on the standard unadjusted fee schedule amounts.”
Cures Act Delay Was About to Expire
The problem of basing wheelchair accessory allowables on figures derived from Medicare’s controversial competitive bidding program for durable medical equipment has been vigorously contested by the CRT industry for almost two years.
The 2008 Medicare Improvements for Patients & Providers Act (MIPPA) exempted CRT from Medicare’s competitive bidding program. But in mid 2015, CMS announced it would use pricing taken from competitive bidding data to create new allowables for accessories used on CRT power and manual wheelchairs.
As a June 23 announcement from the American Association for Homecare (AAHomecare) pointed out, Congress passed two bills to delay the start of the funding cuts. The second delay, part of December’s 21st Century Cures Act, was due to expire June 30.
In the AAHomecare announcement, CEO/President Tom Ryan said, “Today’s announcement marks a big win for home medical equipment providers who furnish CRT products. CMS’ action ensures that individuals with significant disabilities will continue to have access to specialized technology that they depend on, which will also be welcome news for caregivers and medical professionals who support these individuals.”
Manual CRT Wheelchairs Not Part of Deal
The new policy affects accessories on Group 3 power chairs. Manual CRT wheelchairs — such as ultralightweight, self-propelled and tilt-in-space models — were not included in the policy announcement, meaning they are subject to the previously planned funding cuts.
Don Clayback, executive director of NCART, told Mobility Management that the organization would continue to address the subject of accessories for manual CRT wheelchairs.
“As we move forward and work on things like the separate [Medicare benefit] category legislation and other issues, we’re going to look for an opportunity to remove the cuts for the CRT manual accessories and get back to the point where whether it was power or manual, you received the same payment based on the Medicare fee schedule,” Clayback said.
At the same time, he said he recognized the enormity of the policy change concerning Group 3 power chairs.
“It’s a major win to get the power wheelchair accessories taken care of, and so we want to be very appreciative of our Congressional leadership and CMS,” Clayback said. “We really appreciate everyone stepping up, both in Congress and at CMS, and making this policy change, which we’ve been working on for almost two years.”
Clayback added that industry organizations did try to get accessories on both power and manual CRT wheelchairs exempted.
“The message is thanks for the policy change; that’s great. We were hoping to get manual [chairs exempted as well], and we will move forward with further discussions on protecting CRT access, such as the separate category legislation.
“We’re not giving up. But this was a big win, and hopefully, it’s an indication that things will be better.”
