Bill to end capped rental for DME moves forward

Sunday, November 6, 2005

WASHINGTON -- A proposal to eliminate the capped rental option for DME like hospital beds and CPAPs inched forward Nov. 3, when the U.S. Senate passed its Medicare/Medicaid budget for 2006.

But a group of senators led by rehab industry allies Sen. Rick Santorum, R-Pa., and Sen. George Voinovich, R-Ohio, succeeded in getting rid of a provision in the proposal that would have prohibited beneficiaries from purchasing power wheelchairs up front.

The House of Representatives is scheduled to vote on its spending plan, which includes no Medicare provisions, this week. From there, the two plans will go to a Conference Committee, where members of the Senate and House will hammer out a compromise plan, possibly before Thanksgiving. The final plan will be sent to the president for his signature.

The provision for power wheelchairs, which moved the option for purchasing power wheelchairs from the first month to the 10th month, sent the rehab industry in a panic. Beneficiaries usually opt to buy power wheelchairs when they're furnished because, in 99% of cases, they need them long-term, according to Don Clayback, who heads up the MED Group's National Rehab Network.

That also works best for providers.

"It would have taken me 10 months to get money instead of one month, so we would have had to put all that money up front to pay the vendor," said Jim Travis, president of Buffalo Wheelchair in West Seneca, N.Y.

Another troubling scenario that would have played out, had the provision stayed in the proposal: The base of a power wheelchair would have been rented but the accessories would have been purchased.

"The biggest issue was that power wheelchairs shouldn't be a rental item in the first place," Clayback said.

While the power chair provision was removed from the Senate bill, there's a chance, however unlikely, that it could be included as part of a final package, said an industry source.

Providers of DME in the capped rental category have even more to worry about.

Under the Senate proposal moving forward, they'll be forced to transfer the title for DME to the beneficiary after a 13-month rental period. (The option for a supplier to retain ownership of the item after a 15-month rental period would be eliminated.)

By eliminating the capped rental option, providers would automatically lose two months of reimbursement per item (the 14th and 15th months), as well as the twice-yearly maintenance-and-service fee. The fee equals one month's rental.

At this stage in the game, "the best of all possible worlds is that reconciliation doesn't happen this year -- that the House and Senate can't come to agreement, and the package gets put on hold until next year," said Cara Bachenheimer, vice president of government relations for Invacare.

Still, "this capped rental issue is not going away," she said. "If they don't solve reconciliation issues this year, the same package will come back to haunt us next year."