Complex rehab as capped rental?

‘We need to convince CMS this doesn’t make sense’
Friday, July 26, 2013

WASHINGTON – CMS proposes saving millions of dollars by reclassifying certain HME as capped-rental items, but stakeholders say this move doesn’t make sense for pediatric and tilt-in-space complex wheelchairs. 

CMS issued a proposed rule July 3 that, among other things, clarifies the definition of routinely purchased equipment, effectively making about 80 codes, including certain complex rehab codes, capped-rental items.

“They’re basing these savings on the fact that most capped rental items are returned after eight months,” said Rita Hostak, vice president of government relations for Sunrise Medical and a member of the NCART workgroup putting together comments on the rule. “For us (in complex rehab), that won’t happen. These are people with permanent, long-term disabilities.”

CMS anticipates the changes would save $130 million over five years.

Stakeholders say making certain complex rehab capped-rental items would be a lose-lose situation. CMS would have to process claims 13 times instead of once, and providers would have to wait 13 months to receive full payment for high-priced equipment.

“We’re talking about thousands of dollars for this equipment,” said Rex Maxey, president of Binghamton, N.Y.-based Penn York Medical Supplies. “This is the worst thing they could do.”

While some providers have been able to make the capped-rental system work for standard power wheelchairs (a policy CMS put in place in 2011), complex rehab is a different story, stakeholders say. 

“Complex rehab doesn’t have the volume that the Group 2 chairs have,” said Doug Crana, president of Newburgh, N.Y.-based Consolidated Medical. “Being the bank for Medicare, as they make providing this equipment more complicated, would be a very negative thing.”

Stakeholders have until Aug. 30 to comment on the rule. As it currently stands, the changes would go into effect Jan. 1, 2014.

“We need to convince CMS this doesn’t make sense for them or any stakeholder,” said Hostak.


What are the codes?  Where can I find a listing?

I guess it wasn't enough that the HME industry struggled to keep complex rehab out of competitive bidding. Now we have another hurdle; removing the first-month purchase option.  Here we go again with CMS proposing something with a high-probability of disastrous results.  I'd love to sit down with these ignorant bureaucrats and see how many of them have personally dealt with a physical disability. I'd be willing to bet the numbers are very few, or none at all.


Does CMS realize that the people we service and provide equipment to are not just the elderly?

They are people with Cerebral Palsy, Multiple Sclerosis, Paraplegia, Quadraplegia, Tetraplegia and a host of Nueromuscular Disorders.

Do they honstly believe that they only use this equipment for 8 or 9 months?

I have been in this industry for 33 years. With all of the education going on it still amazes me that the people in Washington still do not understand the service and equipment Complex Rehab Providers deliver.

@Laurien This is the link to the proposed rule. The codes are listed in Table 11.

Surely Medicare is not so stupid that they actually think after a chair is custom built for an individual with these particular needs, that anyone would be able to simply rent it to the next guy that needs one! Someone needs to tell the government to stop paying for the free cell phones for the non-working and leave our healthcare benefits ALONE!!!

Do they simply have it in for the elderly and handicapped????