Complex rehab accessories: Stakeholders line up for permanent fix in 2017

 - 
Friday, December 2, 2016

WASHINGTON – The chances are good that industry stakeholders and their champions in Congress will be able to stall CMS’s plans to apply competitive bidding-derived pricing to accessories for complex power wheelchairs for another six months.

Language to that effect has been included in the 21st Century Cures Act, which passed the House on Nov. 30 and is scheduled to pass in the Senate this week.

“We’re pleased to be in the bill and we’re pleased the bill is going to move this early in December,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products. “Last year, we were literally down to the last second of the session before we knew if we’d get relief or not.”

In the last days of December 2015, stakeholders and their champions were able to delay the pricing change for one year, until Jan. 1, 2017.

It’s disappointing that there’s still no permanent fix, but stakeholders say it’s common for lawmakers to “kick the can down the road.”

“I can’t tell you how many provisions that happens to—look at the ‘doc fix,’” said Cara Bachenheimer, senior vice president of government relations for Invacare.

As for expanding the delay to complex manual wheelchairs?

“We were told (by lawmakers), ‘Look, we want to help you and the best way to help you right now is to just change the date on the bill passed last year,” Johnson said.

But stakeholders say there are a number of signs that 2017 may be their year, namely a Republican-controlled Congress and presidency, and what’s looking like Rep. Tom Price, R-Ga., a long-time HME champion as secretary of the Department of Health and Human Services.

Additionally, stakeholders expect a “very active year” legislatively, with Republicans planning for a repeal and replacement of the Affordable Care Act, or at least significant revisions to Obamacare.

“One of the challenges this year was there was limited legislation,” said Don Clayback, executive director of NCART. “When it’s limited, it’s difficult for us to get attached to something. Next year, health care will be a big focus.”

Unlike with the initial 12-month delay—when CMS took six months to get its claims processing system changed to reflect the original, not adjusted, pricing—stakeholders don’t expect any hiccups with this delay.

“One of the questions we’re working on with CMS is, since it’s a pick-up of the existing delay, it should be a minor lift for them,” Clayback said. “All they have to do is continue the current process they have in place.”