Champions join the fray

Friday, February 21, 2014

Complex rehab stakeholders say lawmakers had the same reaction they did to Medicare’s plan to transition certain complex rehab codes to capped rental status.

“They were surprised that CMS relied on 27-year-old data to make their decision, and that more than 170 comments were ignored,” said Don Clayback, executive director of NCART. “CMS has taken a situation that was working, with no funding or access problems, and created a problem with payment and access.”

Stakeholders met with the sponsors of bills to create a separate benefit for complex rehab and Rep. John Larson, D-Conn., on Jan. 22 to discuss this and other concerns about payment and access.

Chief among those concerns: A Nov. 22 final rule that designates 78 codes as capped-rental items—including codes for tilt-in-space manual wheelchairs, pediatric manual wheelchairs, and manual wheelchairs with power-assist. Stakeholders hope lawmakers will intercede before the rule’s April 1 start date.

“They’re going to reach out to CMS to find out more about this,” said Clayback. “After that, we’ll figure out what the next steps are.” 

Stakeholders also brought to lawmakers’ attention the fact that the Office of Medicare Hearings and Appeals has suspended the assignment of hearings for appeals going back to July 15, 2013 (see related story, page 1). Clayback said the issue especially affects complex rehab providers, because if payment is recouped for a claim, providers also cannot be paid for critical modifications and repairs.

“The consequences could be extreme,” he said.