ARLINGTON, Va. — Saying it threatens the quality of
beneficiary care and provider well-being, the American Association
for Homecare's Rehab and Assistive Technology Council called on
the DME MAC medical directors last week to withdraw a new
wheelchair repair policy.
The policy, which went into effect April 1, virtually halves
Medicare coverage for wheelchair repair labor and payment,
according to the RATC.
In comments dated May 11 and signed by AAHomecare President and
CEO Tyler Wilson, the organization called the new policy a "radical
departure" from traditional Medicare coverage policy for payment of
repairs to beneficiary-owned equipment.
The latter establishes coverage for repairs up to the cost of
replacing the equipment. The new policy, however, affixes a time
limit to repairs; providers are prohibited from billing for service
in excess of the policy limits. (See
DME MACs Issue Standard Common Repair Allowances, May 2.)
According to a table in the new policy, for instance, providers
can now bill only two units of service — with each unit
representing 15 minutes of labor — to repair or replace a
power wheelchair battery, regardless of how long the repair
actually takes. The historical average allowable was four
units.
"The problem we have is with the labor reimbursement," said Tim
Pederson, ATS, president and CEO of WestMed Rehab in
Rapid City, S.D., and RATC chair. "It's an unrealistic cap and a
major change in policy. We think they have overstepped their
authority."
According to Walt Gorski, AAHomecare vice president of
government affairs, "The policy imposes arbitrary restrictions on
labor for repairs. There appears to be no basis for these
decisions." He added the restrictions are below providers' cost,
and that imperils quality of care.
"Medicare beneficiaries will be adversely affected because [HME]
providers cannot afford to perform repairs in the limited time that
the DME MACs have determined to be billable," the RATC said in its
comments. "As a result, many HME providers will be unable to
provide the needed items and service to Medicare
beneficiaries."
The comments also questioned the MACs' assertion that the new
policy is a payment policy. It cannot be so, the RATC argued,
"because the policy does not in reality establish the 'fee' for
labor. Rather, it imposes a frequency limitation on coverage for
this service. Consequently, we believe that the DME MACs have
confused a payment determination with what is in fact a coverage
determination."
The RATC pointed out that CMS has already addressed coverage for
repairs, as well as established the payment methodology and the
payment amount. "Any additional action by the DME MACs with respect
to establishing reimbursement for labor is unnecessary," the
Council maintained.
Beyond that, the policy is "procedurally defective and must be
withdrawn," the RATC said, because there was no notice and no
opportunity for comment.
"The DME MACs can do payment policy, but they cannot do coverage
determination as they did it without notice and comment," said
Gorski.
By not getting input, the RATC said, the DME MACs imposed
unrealistic time limitations on providers.
"The DME MACs imposed frequency limits on Medicare coverage for
labor without any consultation with providers. As a result, the new
policy grossly underestimates the time involved in making a
repair," the comments note. "We request that the DME MACs withdraw
the policy and adhere to the repair policy specified under the
[Medicare benefit and claims processing] manuals."
Should the MACs elect not to rescind the policy, the association
said they should at least withdraw the policy and issue a proposed
policy with an appropriate comment period.
"These are very concerning and distressing changes," Gorski
said. "This is a quality-of-care issue, a beneficiary issue. It's
the beneficiaries who suffer. We hope to change the minds of the
medical directors in order to have this policy changed."
