CMS dumps cushions from Round 2

Thursday, December 29, 2011

WASHINGTON - The complex rehab industry had another reason to celebrate last week when efforts to remove skin protection wheelchair cushions from Round 2 of competitive bidding finally paid off. 

Industry efforts to exclude the four codes (E2622, E2623, E2624 and E2625) began even before Round 1 was implemented Jan. 1, 2011, and CMS agreed to make the change Dec. 28. 

"The position that we've taken all along is that you shouldn't bid an under-defined code," said Dave McCausland, senior vice president of planning and government affairs for The Roho Group. "If you've got a code that includes a variety of products that really don't make up a homogeneous group, then you place the beneficiaries at risk."

Earlier in December, CMS agreed to remove ultralight manual wheelchairs, gimbaled ventilator trays and push activated power assist devices (K0005, E0986 and E1030) from Round 2.

Skin protection cushions weren't a good fit for competitive bidding because providers would be forced to submit bids for only a few types of cushions when there are many available, limiting access for beneficiaries with different skin issues and positioning needs, stakeholders say.

"That would be extremely detrimental to folks with disabilities," said Simon Margolis, executive director of NRRTS. "They're not custom made, but they certainly have a need for custom fitting."

Stakeholders are pleased CMS listened to the industry and made the change.

"We appreciate seeing this level of compassion, interest and understanding coming from a CMS administrator," said Tom Borcherding, president of The Roho Group.

Despite the victory, the fight to protect complex rehab from competitive bidding and other threats is far from over, industry stakeholders warn. 

"It is important to understand that our efforts must continue to obtain long-term change and stability," said Rita Hostack, vice president of government relations at Sunrise Medical. "The issues related to the inclusion of CRT codes in Round 2 provided real life examples of the need for a separate benefit category."