Legislators wrestle over eliminating capped rental option

WASHINGTON - A proposal that would prohibit beneficiaries from buying a power wheelchair in the first month of rental may come back to haunt the rehab industry. In November, powerful industry allies, including Sen. George Voinovich, R-Ohio, succeeded in eliminating the proposal from the Medicare/Medicaid spending package. As part of behind-the-scenes negotiations that change things "by the half hour--if not by the minute," however, the proposal could be reinstated, according to Cara Bachenheimer, vice president of government relations for Elyria, Ohio-based Invacare. "(The proposal) was removed, but it's still under consideration because we now have the staff of (Rep. Bill Thomas, R-Calif.,) questioning Voinovich's amendment," she said. "Everything is extremely fluid at this point--and not in a good way." Senate and House conferees were scheduled to begin formal compromise talks on the package Friday. But with Senators planning to break for the holidays on Saturday, there's a chance that the issue might not be resolved until early next year. After the package goes through reconciliation, it goes back to the House and Senate for final votes. The rehab industry opposes the proposal because, in the majority of cases, beneficiaries opt to purchase power wheelchairs in the first month. Without that option, the industry says, predicaments like the following could become commonplace: The base of a wheelchair would be rented but accessories would be purchased. Even if the proposal remains off the table, the industry has another proposal in the Medicare/Medicaid package to grapple with: eliminating the capped rental option for DME like CPAPs and hospital beds. That proposal would impair a beneficiary's ability to get equipment serviced and impact a provider's bottom line, according to industry sources. If it stands, providers stand to lose two months reimbursement per item, as well as the twice-yearly maintenance fee they receive for serving capped items. Senator staffers, relying on a 2002 OIG report, believe the maintenance fee is unnecessary. "This is a very difficult issue for us, simply because we're up against an OIG report that, if you know nothing about the industry, seems to make absolute sense," Bachenheimer said. "But when you start talking about how beneficiaries are going to have difficulty obtaining maintenance and repair services for equipment once it's purchased--members of Congress say that's absurd." Rep. Bill Thomas, R-Calif., and Sen. Charles Grassley, R-Iowa, were among the conferees expected to begin talks on the package last week.