The battle continues for accessories

Monday, February 22, 2016

It is quite remarkable that Congress has to pass a law to get Medicare to follow a law passed seven years prior, and beyond disturbing that when Congress does take such action, Medicare responds with an unprecedented six-month implementation delay, which will pay providers the reduced rate during that period. It really makes you wonder who is in charge. It appears that Medicare may be accountable to no one.

Sadly this is true when it comes to the complex rehab accessory legislation, S. 2425, which was passed by Congress and signed by the president late last year. The bill was a compromise by the industry to agree to a one-year delay in implementation of the application of bid rates for standard wheelchair accessories being applied to complex rehab wheelchair accessories rather than a permanent exemption as provided for in H.R. 3229 and S. 2196. 

Congressional support has never been stronger for complex rehab and many legislators are quite upset (to put it mildly) that Medicare appears to be defying Congress again on this issue. Our request to Congress is to:

• Implement the changes no later than March 1; 

• Immediately issue formal written guidance to inform Medicaid, other insurance programs, and Medicare beneficiates that these changes are effective Jan. 1, 2016, but will not be put into the Medicare claims processing system until March 1; 

• Establish a system that will automatically calculate and pay the payment adjustments for claims, including interest, submitted prior to March 1 without requiring suppliers to “resubmit” or take any other action; and 

• Include a “beneficiary message” on any EOB for these codes, notifying the beneficiary that there will be a future adjustment to the allowed amount.

Beyond the implementation issues, the delay legislation also requires a Government Accountability Office (GAO) study to be provided to Congress by June 1 with recommendations on how to proceed on the CRT accessory issue. The report is to evaluate wheelchair accessories and seat and back cushions used on Group 3 powerwheelchairs. 

Helping educate the GAO on the complex rehab industry is a top priority. Our goal is to make sure they understand that complex rehab wheelchairs and related accessories are used by a small population of people with high-level disabilities. In addition, within the Medicare program these individuals represent a small (less than 10% of all Medicare beneficiaries who use wheelchairs) but very vulnerable group of people with significant disabilities that need specialized equipment, which by law must be provided through a clinical team model that requires multiple evaluations, configuration, fitting, adjustment and programming. The recommendations in the GAO report will largely determine the next steps by Congress to provide for the permanent relief that is needed to truly protect access to complex rehab technology. We have been told by our champions on Capitol Hill that the best thing we can do as an industry is to continue to increase the co-sponsors on H.R. 3229 and S. 2196 that would provide permanent protection for the impacted CRT items. 

Our strong and consistent advocacy efforts last year paid off with the one-year delay. I am confident if we build off of those efforts this year with Congress we can and will secure permanent relief for complex rehab technology. Are you with me? Let’s do this!

Seth Johnson is senior vice president for Pride Mobility / Quantum Rehab. He can be reached at 1-800-800-8586.