Stakeholders Fight for Revision of CMS’ New PMD Fee Schedule

BALTIMORE–With less than a month to go until CMS’ new fee
schedule for power mobility devices takes effect, the American
Association for Homecare said its Rehab and Assistive Technology
Council sent a letter to HHS Secretary Michael Leavitt and CMS
staff last week asking for a delay.

The new pricing, issued Oct. 2 and scheduled to be implemented
Nov. 15, cuts reimbursement by more than 40 percent for some
equipment (see HomeCare Monday, Oct. 9). As a result,
stakeholders said that it will be difficult for providers to remain
profitable in the rehab business, and some are now warning that
layoffs are inevitable.

“We [believe] that the new payment levels are far too low to
support appropriate access to PMDs for Medicare beneficiaries,
especially in light of the new coverage, documentation and quality
standards that suppliers will be required to meet,” the letter
said, noting that the new fee schedules “significantly undermine
the progress CMS has made to date in these other areas and pose
what may be insurmountable barriers to access for Medicare
beneficiaries.”

The letter adds that the delay would give CMS the opportunity to
work with stakeholders to come up with payment amounts that are
“realistic and equitable” using the data and analysis from a Muse
& Associates study presented to CMS earlier this year.

The study, which was commissioned by AAHomecare, pointed out
problems with CMS’ gap-filling methodology for setting fees (see
HomeCare Monday, Sept. 19, 2005).

Patient and beneficiary advocacy organizations also are
mobilizing to fight the new cuts. Last week, a statement from the
American Association of People with Disabilities, the Clinician
Task Force and the Independence Care System lambasted the PMD fee
schedule. “Already, many suppliers from around the country say they
will stop providing mobility equipment or go out of business
because the Medicare reimbursement payments will be too low to
cover the cost of acquiring the chair, fitting the patient and
servicing the equipment,” according to the statement.

“This is an intolerable situation that amounts to dismantling an
important Medicare benefit for senior citizens and people living
with disabilities,” said Andrew Imparato, president and CEO of the
American Association of People with Disabilities. “There will be a
loud and powerful outcry. CMS won’t be allowed to turn back the
clock on providing a critical piece of medical equipment for people
who need mobility assistance.”

“We cannot allow CMS to let these vast policy changes stand,”
said Laura Cohen, co-coordinator of the Clinician Task Force.
“Clinicians, physicians and advocates for senior citizens and
people living with disabilities will be asking Congress to
intervene and ensure that the elderly and some of the most
vulnerable people in our society can obtain necessary mobility
equipment through the Medicare benefit.”

Meanwhile, some are predicting that the deep power mobility cuts
could result in layoffs.

“The bottom line is that we won’t be able to service the custom
wheelchair market anymore without Medicare retracting this new fee
schedule,” said Jim Greatorex, president of Portland, Maine-based
Black Bear Medical, which said in a statement last week that
layoffs are likely under the new fee schedule.

Greatorex said he fears that private insurance companies, which
often look to Medicare when creating their own policies and fees,
will insist on similar cuts.

“There has been a concerted effort by CMS over the last three
years to dismantle the Medicare mobility benefit,” he said. “In the
past, we have politely worked with them to make their policies
reasonable. But now we are taking gloves off. It is time to play
hardball. These price cuts go far beyond what anyone could consider
reasonable.”