Breaking Alert: CMS Rescinds Implementation of Complex Rehab Power Wheelchair Accessories into Competitive Bidding
Since 2014, Complex Rehab Technology (CRT) providers have been fighting a battle to keep CRT wheelchair accessories from being inappropriately paid based on competitive bidding program information. Today, the Centers for Medicare and Medicaid Services (CMS) announced that it would be overturning its decision to use competitive bid rates to determine payment amounts for CRT power wheelchair accessories.
As a point of clarification, this is only covering group 3 complex power wheelchairs. From the announcement: “21st Century Cures Act currently allows higher payments for these items but is set to expire after June 30, 2017. By continuing these higher payments, this new action will help to protect access to complex rehabilitative power wheelchair accessories on which people with significant disabilities depend.”
Click here to read the full announcement.
To provide a little background on the issue, in November 2014, CMS issued final rule CMS 1614-F which outlined the nationwide application of competitive bidding payment rates to non-bid areas. In December 2014, CMS released a Frequently Asked Questions (FAQ) document, which indicated CMS would use this bid pricing on CRT wheelchair accessories. This clearly conflicted with 2008 Congressional legislation, Medicare Improvements for Patients and Providers Act (MIPPA), that specifically exempted CRT from the program.
There have been several efforts including congressional letters, legislation, and committee inquiries on the issue. The team at the National Coalition for Assistive & Rehab Technology (NCART) carried the torch for the CRT industry to find a solution to this issue and a lot of credit goes to the grassroots providers that continued to press the issue with their members of Congress. Don Clayback, executive director for NCART, made this issue his primary focus and with the assistance of U.S. Rehab, AAHomecare and others, CRT stakeholders continued to keep this issue high on the priority list of congressional offices.
Greg Packer, president of U.S. Rehab, offered great praise to the providers on the ground saying, “We are thrilled to share that CMS has made the right decision to change course on applying competitive bid pricing to CRT wheelchair accessories. The clear intent of Congress by both law and other inquiries was to keep CRT out of the competitive bidding program. Due to the constant effort of U.S. Rehab providers remaining engaged with their members of Congress, the industry received a huge win today.”
VGM Government Relations Director, Tom Powers added, “CRT providers serve some of the most vulnerable patients in health care who heavily rely on this specialized equipment to maintain their independence and continue to be active citizens. This is a well-deserved win for CRT providers and beneficiaries across the country as the industry works to implement sustainable health care reforms that put patients first.”
Without the hard work and dedication of stakeholders and grassroots providers, the pressure coming from Capitol Hill to implement these urgent reforms likely would not have happened. Plenty of work remains on the next priority of the industry which is creating a separate benefit category for CRT. U.S. Rehab remains committed to continuing conversations and building relationships on Capitol Hill to advocate on behalf of its membership and the beneficiaries they serve.
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Help Stop Cuts to CRT Wheelchair Accessories
The KU modifier was established to allow reimbursement from the UNADJUSTED fee schedule for accessories used on Group 3 power bases for dates of service Jan. 1, 2016 – June 30, 2017. Yes, I said June 30, 2017, and as of today the KU will be eliminated come July 1, 2017. What this means to you is the reimbursement rate for a Group 3 multiple power accessories will be reduced by approximately $1,500 per claim.
Contact your congressional representatives, and ask them to sign on to H.R. 1361/S. 486, which will extend the protection of accessories used on Group 3 bases from the competitive bid ADJUSTED fee schedule. Don’t take NO for an answer! Explain that if this is not passed, many of THEIR CONSTITUENTS will NO longer have access to medically necessary complex rehab equipment. See who has signed on. Visit the VGM Government Relations website to send letters to your representatives to ask them to sign onto the bills.
Providers of CRT will be at greater risk of facing cuts, therefore harming the well-being of consumers with disabilities.
This bill must be passed by Saturday, June 30th, 2017, and we need your help to urge your representatives to sign on. To contact your local congress member, please follow this link.
CRT Wheelchair Accessories Overview
Letter to Secretary Price
GAO Report Validates Need for Passage
Medicare Data Identifies 30% to 40% Nationwide Drop in CRT Providers
Co-sponsors of CRT Accessories Bill at 5-18-17 Compared to Last Session