Relief on the way for complex rehab providers

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Friday, December 20, 2019

WASHINGTON – In a hard-fought win, industry stakeholders have succeeded in getting Congress to suspend competitive bidding pricing for accessories for complex manual wheelchairs.

Both the House of Representatives and the Senate last week passed H.R. 1865, a year-end spending bill that includes language requiring CMS to stop applying bid pricing to these accessories for 18 months starting Jan. 1, 2020.

“This really has been a four-year battle that involved getting resolutions for complex power and complex manual wheelchairs,” said Don Clayback, executive director of NCART. “Thanks to everyone’s hard work, including the hard work of our champions in Congress, this protection for complex manual wheelchairs is a big accomplishment.”

The House passed the bill 297-120; the Senate 71-23. The president signed it Friday.

Stakeholders will now work with CMS on what they believe will be a fairly straightforward fix that involves allowing providers to also use the KU modifier for accessories for manual, not just power.

“We will be working with CMS on the implementation, but the good news is that there should be minimal system changes for CMS,” Clayback said. “The fee schedule doesn’t change; it’s simply a claims edit modification.”

Additionally, CMS had to make a similar fix when it agreed not to apply bid pricing to accessories for complex power wheelchairs starting July 1, 2017.

“The transition for manual shouldn’t take as long as it did for power,” said Seth Johnson, vice president of government affairs for Pride Mobility Products. “They’ve already done the work.”

The language in H.R. 1865 also specifically adds complex manual wheelchair bases and accessories to the complex rehab carve-out from the bid program from 2008.

“This was always the intent of Congress,” Clayback said.

Laying the groundwork for the language being included in and passing as part of H.R. 1865: Reps. John Larson, D-Conn., and Lee Zeldin, R-N.Y., introducing H.R. 2293 in April; and Sens. Bob Casey, D-Pa., and Rob Portman, R-Ohio, introducing S. 1223 also in April.

Late in 2018, similar language was passed by the House as part of H.R. 7217, but it stalled in the Senate at the 11th hour, amid a government shutdown.
Stakeholders have been trying to stop CMS from applying bid pricing for accessories for years. In 2015, industry champions were able to stave off bid pricing for accessories for complex power wheelchairs for a year. In 2016, they were able to do it again for another six months. CMS, ultimately, agreed not to apply bid pricing for accessories for complex power wheelchairs.

Bid pricing for complex manual wheelchairs, however, has been in place since Jan. 1, 2016.