CMS proposal oversimplifies wheelchair provision

Friday, July 18, 2014

WASHINGTON – The devil’s in the details, and the lack of details in CMS’s proposal to implement bundled monthly payments for standard manual and power wheelchairs has stakeholders on edge.

“There are so many more questions that this proposal raises than it answers, and that should probably be more troubling than anything else,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

CMS states in a proposed rule published in the Federal Register on July 11: “We propose that the suppliers would submit a single bid for each HCPCS code describing the wheelchair for each CBA for furnishing the wheelchair and all accessories (including batteries) and services needed on a monthly basis.”

One big hole in CMS’s proposal: Stakeholders don’t know what kind of data providers will have at their disposal to develop these bids.

“I don’t see how you can put together an intelligent bid because patient needs will vary so significantly,” Bachenheimer said.

CMS is also soliciting comments on whether standard manual and standard power wheelchairs should each be described under one HCPCS code.Bundling is not a new idea. But grouping everything under one code?

“That’s just insane,” Bachenheimer said.

CMS claims using bundled monthly payments in lieu of capped rental payments would help to fix repair issues, but stakeholders beg to differ.

“Most of the items that will require repair in the short- to mid-terms are already beneficiary owned and the proposal would only apply to newly-provided products and services, so it still does not sufficiently address the lion’s share of the problem,” said Seth Johnson, vice president of government affairs at Pride Mobility Products.

CMS’s proposal—the bundled payments, the single codes—speaks to the agency’s ongoing lack of understanding about how wheelchairs are provided, stakeholders say.

“It just is really incredible how they’re portraying the simplicity of this when in reality it’s going to be tremendously complicated,” said Don Clayback, executive director of NCART.