CMS stuns with stance on accessories

‘Misapplication’ could mean 25% reduction in reimbursement for complex rehab accessories
Friday, February 6, 2015

WASHINGTON – CMS has released an FAQ indicating that competitive bid pricing for standard wheelchair accessories will be applied to complex rehab wheelchair accessories as part of a national expansion of the program slated for Jan. 1, 2016.

CMS released the FAQ after mobility stakeholders asked for clarification on a recent final rule mapping out the expansion.

“Basically, what CMS is saying is each code is only going to have one price determined by the competitive bidding rate,” said Don Clayback, executive director of NCART. “This is a misapplication of the competitive bid pricing expansion legislation.” 

Complex power wheelchairs and the accessories that go with them were exempted from competitive bidding in the Medicare Improvements for Patients and providers Act (MIPPA) in 2008. 

Because payment rates haven’t been established yet, mobility stakeholders say it’s difficult to know what impact the expansion will have on providers, but it could be significant.

“We’re calculating what the impact could be,” said Clayback. “It could be upward of 25% or more.”

While Peter Rankin, government affairs manager for AAHomecare, hopes that CMS included the complex rehab accessories in error, he’s not holding his breath.

“We’ve drafted a letter to CMS pointing out the agency’s overreach and talking about the impact that it would have on beneficiaries,” he said. “It’s not like providers are selling millions of complex chairs with a million different accessories and CMS has to rein in spending.”

In the event that CMS ignores industry concerns, mobility stakeholders will have to turn their sights on Capitol Hill. 

“CMS could change this through regulation—and that’s the easiest option—but if they’re unwilling to do that, we need to go to Congress and have them make a change through legislation,” said Clayback.

Here is the unofficial list of codes that will likely be impacted.