CMS comes through on wheelchair accessories

‘We have a little extra bounce in our steps’
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Friday, June 23, 2017

WASHINGTON – With only days to spare, stakeholders have succeeded in getting CMS to refrain from cutting reimbursement for accessories for complex rehab power wheelchairs.

The agency announced late on Friday that it would not apply competitive bidding pricing to accessories on July 1, 2017.

“This speaks well of the CRT community, including the consumers,” said Don Clayback, executive director of NCART, who was on the Hill the week of June 19. “It has been a year and a half of very hard work.”

CMS said in the announcement that it has “reconsidered” and decided to preserve reimbursement for accessories for Group 3 or higher complex rehab power wheelchairs. It said providers should continue to use the KU modifier when billing for accessories with dates of service beginning July 1. It said no additional action would be required.

CMS did not, however, extend the policy change to accessories for complex rehab manual wheelchairs.

“We will pursue relief from last year’s cuts to these accessories as we continue to work with Congress and CMS to protect access,” Clayback said in a bulletin to members.

Upon hearing from champions in Congress this week that a fix was in the works, Seth Johnson, vice president of government affairs for Pride Mobility Products, said, “It sounds like a positive development. We have a little extra bounce in our step. Things are moving.”

CMS originally planned to apply bid pricing to accessories on Jan. 1, 2016, but Congress intervened in December of 2015, passing legislation with a one-year delay, and again in December of 2016, passing legislation with a six-month delay.

Pressure has been high to stop the cuts. NCART and NRRTS, as well as the United Spinal Association, hosted congressional fly-ins in April and June, and one of their “asks” was getting legislators to, once again, intervene.

Then in June, a “Dear Colleague” letter signed by 154 members of the House of Representatives was sent to HHS Secretary Tom Price and CMS Administrator Seema Verma, asking them to use their authority to stop the cuts. 

Additionally, in March, bills were introduced in the House and Senate to stop the cuts. Sens. Bob Casey, D-Pa., and Rob Portman, D-Ohio, introduced S. 486; and Reps. Lee Zeldin, R-N.Y., and John Larson, D-Conn., introduced H.R. 1361. The bills have 21 and 101 co-sponsors, respectively.

Stakeholders have argued that accessories for complex rehab wheelchairs, like the wheelchairs themselves, are exempt from competitive bidding per the Medicare Improvements for Patients and Providers Act of 2008, or MIPPA.

Yet CMS issued a “Frequently Asked Questions” document in December 2014 that outlined their plans to use pricing obtained from its bids for accessories for standard wheelchairs to reduce reimbursement for accessories for complex rehab wheelchairs. Accessories for complex rehab wheelchairs include seat/back cushions, tilt/recline systems and specialty controls.

As part of the policy change, CMS has now revised that FAQ.