CMS stonewalls Congress on accessories

Friday, February 26, 2016

WASHINGTON – CMS has yet to respond to calls by lawmakers to restore reimbursement for accessories for Group 3 power wheelchairs by March 1, industry stakeholders say.

“Congress is very, very frustrated that CMS has stonewalled them,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “They’re continuing to pressure CMS on this issue, because it’s not a polite request. It’s a law.”

In January, CMS announced it will use an adjusted fee schedule based on competitive bidding rates for these accessories, despite a law passed in 2015 delaying that change for one year. CMS has instructed providers to resubmit claims on or after July 1, 2016, to get paid the proper amount.

If CMS ignores the March 1 deadline, stakeholders are targeting April 1, they say.

“Generally, the contractors make (system) updates based on the quarter, so the soonest we’d probably be able to get the implementation date moved up is April 1,” said Seth Johnson, vice president of government affairs for Pride Mobility Products.

Other than political pressure, Congress has few options—if any—to force CMS’s hand.

“Theoretically, Congress could defund CMS, but they’re already funded for the fiscal year,” said Bachenheimer. “However, if there were a nuclear option, I’m pretty sure that our champions on the Hill would use it.”

In the meantime, stakeholders are focusing their efforts on the Government Accountability Office report required by that same law, which could be used to support two bills that would provide a permanent fix.

“The GAO report is incredibly important because their report will hopefully illustrate the complexity of these items and give Congress some specific ideas on how to prevent these accessories from being impacted by competitive bid prices,” said Bachenheimer.

Though unlikely, the GAO report could possibly bolster the industry’s long-standing efforts to create a separate benefit category for complex rehab, says Don Clayback, executive director of NCART.

“Assuming they have enough time to sufficiently educate themselves on all aspects of rehab technology, someone taking a closer look could provide support both on the accessory issue and on the broader complex rehab technology issues,” he said.