Congressman supports exempting rehab from NCB

Sunday, May 22, 2005

WASHINGTON -- A U.S. congressman has agreed to sponsor a bill that would remove high-tech rehab and assistive technology from Medicare's national competitive bidding program.

The National Coalition for Assistive and Rehab Technology (NCART) declined to reveal the identity of the congressman who agreed to sponsor its carve-out bill. NCART Executive Director Sharon Hildebrand did say that the rep sits on the powerful Ways and Means committee.

At the moment, NCART is at the mercy of Congress. The carve-out bill would not be voted on as stand-alone legislation and currently there's no Medicare or Medicaid bill to attach it to, Hildebrandt said.

"If not this year, next year," she said.

Unlike a concentrator or hospital bed, a high-tech wheelchair is often fashioned from many different components for an individual user. Therefore, no uniformity of pricing exists, making it inappropriate for competitive bidding, NCART members contend.

While nothing has been set in stone, Hildebrandt envisions products being carved out based on HCPCS codes with some consideration give to diagnoses codes.

"CMS has come out with 49 codes for power wheelchairs and conceivably some of those codes would be more applicable to the disabled population, someone who needs high-tech rehab, but it may also be influenced by the kind of diagnoses that is seated in that chair," she said.

The Medicare Modernization Act of 2003 mandates that CMS begin competitive bidding in 2007. The law allows products to be exempt from competitive bidding if they are "not likely to result in significant savings" or if they "have a greater therapeutic advantage to individuals."

Some industry watchers believe CMS officials recognize high-tech rehab's unique requirements and will exclude if from competitive bidding, but NCART members are taking nothing for granted, Hildebrandt said.

"We believe that we need to cover our bases," she said. "Your never know what a federal agency will do, and when they come out with a rule, it can be really hard to change it."