NCART Reaches Out to State Medicaid Directors on PMD Fee Schedule

WASHINGTON–The National Coalition for Assistive and Rehab
Technology has sent a report to state Medicaid directors urging
caution in the adoption of Medicare’s new power mobility device fee
schedule.

NCART said the report, “Adopting Medicare Power Mobility
Policies Will Impact the Provision of Appropriate Client Services,”
is an attempt to work proactively with state programs as they
implement the 64 new HCPCS codes for power mobility. It includes
background information, documentation and data on the various
Medicare PMD polices and how they are related.

The report also highlights two issues–pricing and coverage
policies–which the coalition said could “dramatically impact
access to appropriate technology for Medicaid recipients if caution
is not used in adopting these Medicare policies.”

The report is accompanied by a letter, copied to each state’s
governor, explaining that CMS’ new fee schedule, which took effect
Nov. 15, is a discount off previous power mobility pricing. “Even
with the latest adjustments, the fee schedule still represents a
10-30 percent decrease in reimbursement when compared to the fee
structure in effect prior to Nov. 15,” NCART Executive Director
Sharon Hildebrant explained in the letter.

She also pointed out that suppliers who provide complex rehab
and assistive technology must employ trained specialists and are
burdened by costs, with 97 cents out of every dollar spent on
providing the equipment. “Any efforts to further reduce pricing
from the Medicare fee schedule will block access to medically
appropriate technology,” Hildebrant wrote.

“The Medicare fee schedule must be viewed as the minimum payment
level by all state Medicaid programs. Moreover,” the letter
continued, “consideration should be given to increasing
reimbursement above the Medicare fee schedule should your state be
primarily rural in nature or other special circumstances exist,
such as additional processing requirements.”

NCART also gave the state directors a recommended coverage
policy for power wheelchairs that removes the restrictive reference
to “in the home” used by the Medicare program.

To view the report and the letter, visit www.ncart.us.