Legislation that would have protected funding for accessories used on complex rehab technology (CRT) wheelchairs has been left out of the omnibus spending bill that Congress will vote on this week.
Despite intensive efforts by CRT associations, consumer advocacy groups and other stakeholders, the provision was not part of the bill whose text was revealed late Tuesday, Dec. 15.
CRT advocates and consumers had sought to stop a Centers for Medicare & Medicaid Services (CMS) plan to sharply cut payment amounts for 171 HCPCS codes for wheelchair accessories by using competitive bidding rates to determine new payment amounts.
New reimbursement rates are due to start Jan. 1. When the 2016 Medicare fee schedule was released in late November, NCART noted “major reductions as high as 30 to 40 percent or more” for those wheelchair accessories.
Industry advocates contended that using Medicare competitive bidding payment amounts to determine funding was not allowed because of the 2008 Medicare Improvement for Patients & Providers Act (MIPPA).
H.R. 3229, a House of Representatives bill introduced in July by Rep. Lee Zeldin (R-N.Y.), sought to close what many in the industry believed was a language loophole being used by CMS to cut accessory funding. S. 2196 was the companion Senate bill.
Wheelchair accessories used by adult and pediatric clients would be impacted by the cuts. Affected accessories range from ventilator trays for wheelchairs to powered seating options such as tilt and recline, power chair electronics and driving controls, wheelchair seat cushions and backrests, manual wheelchair tires and caster forks.
Speaking to Mobility Management the morning after the text of the omnibus bill was released, NCART Executive Director Don Clayback said, “The message right now is that we didn’t make the omnibus bill last night, but we continue to have discussions with our Senate and House champions on what might be some other options.”
Clayback indicated that being left out of the omnibus bill was likely the result of the multitude and magnitude of activity going on as Congress winds down.
“We are disappointed,” he said. “I think our small issue got caught up in the bigger political discussions, but the good news is our champions still recognize this is something that needs to be fixed, and we’re having conversations along those lines.”
Clayback characterized ongoing efforts and conversations as “targeted” at this point, noting, “We’ve communicated to Congress the importance of this issue and the fact is I really think we’ve gotten good support, but [the CRT legislation] just got caught up in these bigger discussions.”
He recommended that stakeholders stay tuned for further updates.
“I think we’ve done a good job of raising the issue and gaining support,” Clayback said. “Now it’s at that position at that high level that it’s being balanced with a lot of other things that Congress is dealing with. That’s what our champions are wading through now.
“Discussions are going on at a high level within Congress, and we’ll provide additional information as soon as we have it.”
The Impact on Consumers
Lorenzo Romero, president of Stealth Products in Burnet, Texas, told Mobility Management that wheelchair users with the most complicated seating & mobility needs would be hardest hit should the funding cuts go into effect Jan. 1.
“It definitely means limited access to very critical products,” he said. “In this particular case, the end user is going to pay a significant price for the cut.”
Romero anticipates that lower allowables will mean clinicians will be forced to choose – and consumers will be forced to live with – cheaper products that are less functional, less robust, less adjustable or less durable than the products they’ve successfully used in the past.
“In some cases, people are just not going to have a product that they’re absolutely needing,” he said. “Like tilt and recline or alternative controls. And positioning belts took a major hit. It could be something as simple as a lap tray, [whose reimbursement] has already been slashed multiple times over the years, and it is now taking another hit. We make those trays to provide a service, but it’s very costly to manufacture a tray.”
Complex rehab technology costs more to design, develop, test and build than out-of-the-box products, Romero noted. But CRT’s unique nature, including one-of-a-kind specifications or configurations, is what ultimately makes so many CRT products effective.
“With joystick bracketry mounting, a half a millimeter can make the difference between someone successfully driving a chair and not driving a chair,” he said. “If you were to take a tour of Stealth, you would find that 75 percent if not more of our business is custom — custom configurations, custom one-offs,” he said. “You absolutely cannot just walk down the aisle and pick what you like [off a shelf]. It’s very specific to the end user and their need. There are so many ways you can configure a headrest, and so many ways you can configure a seating system.”
Romero added that these funding cuts are hitting a group of consumers unable to use lesser products.
“This is the most complex part of the industry,” Romero said, “and there are people who just have no choice but to use a specific product or a specific configuration that there is no other way to replicate.”
Cutting the funding for the technology that helps these end users to get out of their homes, go to work or school, and be active in their communities feels like a step backward, Romero said.
“There are parts of the world where people don’t have access and independence, and I’ve always taken a lot of pride that we do the best job in providing those things,” he said. “But I feel like we’re taking a step back in time here. Folks are going to be more dependent and less able to grow as people and experience life as other people do. That is going to be taken away from them.”
As for how Stealth Products will deal with the impending cuts and the ripple effects sure to come, Romero said those things will have to be discussed.
“We’ve always believed in being creative and innovative and figuring out ways,” he said. “It just means we’re going to have to look harder at better technologies and processes. This is the biggest cut I’ve ever seen. This is substantial. Being able to give someone independence is a pretty rewarding part of the business, but unfortunately, it’s the part that’s being affected the most right now.”
This is a Breaking News story. Stay tuned for further developments and responses.
