As the clock runs down to the April 1 Medicare capped-rental implementation date for a long list of wheelchair-related products, complex rehab technology stakeholders are seeking relief via several different avenues.
Don Clayback, executive director of the National Coalition for Assistive & Rehab Technology (NCART), said in a March 6 bulletin that industry members are trying to secure an implementation postponement till at least July 1.
On March 6, Sen. Thad Cochran (R-Miss.), Sen. Charles E. Schumer (D-N.Y.), Rep. Joseph Crowley (D-N.Y.) and Rep. Jim Sensenbrenner (R-Wisc.) sent a letter to Marilyn Tavenner, administrator for the Centers for Medicare & Medicaid Services (CMS), to ask for an implementation delay.
Regarding the capped-rental transition, the letter said, “Of particular concern is the reclassification of complex rehab technology (CRT) products. CRT includes medically necessary, individually configured manual and power wheelchairs and other specialized equipment that require evaluation, fitting, configuration, adjustment or programming. Medicare beneficiaries, as well as individuals with long-term disabilities, will be affected negatively by this reclassification.”
The Senators and Congressmen say they appreciate efforts to curb Medicare waste and fraud, but object to the capped-rental list being created based on Medicare claims data that is “more than 27 years old and fundamentally flawed.”
Because CMS has stated that Congress would need to act if it wanted CMS to use different criteria, the letter said, “We would appreciate time to try to address this concern appropriately, and therefore request that you delay the implementation of the final rule to at least July 1, 2014. A delay would allow for the development of appropriate classification policies that provide patients with medically necessary CRT equipment in a reasonable and cost-effective way.”
Cochran and Schumer introduced a Senate bill last year that would put CRT in a Medicare benefit category separate from the current Medicare DME benefit category. Crowley and Sensenbrenner introduced a House bill last year with the same goal.
As members of both U.S. houses urged an implementation delay, consumer advocacy groups lobbied CMS in support of a postponement, Clayback said.
In addition, Clayback said, “We have requested details from the PDAC (Medicare’s Pricing, Data Analysis & Coding contractor) on the last three years of claims submission data for the reclassified CRT codes and have been told we will have it by the end of (March). We expect this to clearly show that if CMS applied their rule using the most currently available data for items that did not exist back in 1986, those CRT items would remain in the routinely purchased category.”
