Lawmakers side with industry on capped-rental change

Friday, March 14, 2014

WASHINGTON – A group of lawmakers has asked CMS to delay the transition of certain complex rehab items to capped-rental status on April 1.

In a March 6 letter to CMS Administrator Marilyn Tavenner, two senators and two representatives ask the agency to delay the transition until at least July 1 “to allow for the development of appropriate classification policies that provide patients with medically-necessary CRT equipment in a reasonable and cost-effective way.” 

CMS has based its decision to change the status of the codes “on Medicare claims data that is more than 27 years old and fundamentally flawed,” wrote Sen. Thad Cochran, R-Miss., Sen. Charles Schumer, D-N.Y., Rep. Jim Sensenbrenner, R-Wis., and Rep. Joseph Crowley, D–N.Y.

Stakeholders have requested claims data from the Pricing, Data Analysis and Coding contractor (PDAC) to show that, had CMS used currently available claims data for items that did not exist in 1986, it would have placed the codes in question in the routinely purchased category. They expect to receive the data by the end of March.

At the same time that they’re fighting to delay the transition, stakeholders are also crafting a Plan B if it goes into effect as scheduled.

“I think the strategy will be to share what the impact will be on the marketplace, and if people are having difficulty getting equipment, those are stories we’ll share with Congress,” said Don Clayback, executive director of NCART.

All efforts have targeted not only delaying the change, but also eliminating it. 

“One of the things we saw with the K9 issue last year is we focused a lot on delay, but there wasn’t as much talk about just getting it eliminated,” said Doug Westerdahl, secretary/treasurer of NCART. “So now we’re really focusing on delay and getting the whole thing removed altogether.”