GAO Report on Complex Rehab Accessories Presented to Congress

WASHINGTON, D.C. (June 8, 2016)—A newly released GAO report, “Medicare: Utilization and Expenditures for Complex Wheelchair Accessories,” was presented to Congress on June 1, 2016, just 30 days before prices derived from CMS’s flawed bidding program for home medical equipment are set to take effect for specialized complex rehab technology (CRT) wheelchairs used by individuals with profound mobility and disability challenges.

From the findings in the report, it is estimated that the rates for CRT will be cut 10 to 34 percent when 100 percent of the competitive bid program (CBP)‐adjusted rates are implemented on July 1, 2016.

This is based off the fact that on July 1, CMS will again move forward with inappropriately applying CBP pricing information to CRT wheelchair accessories, unless Congress passes H.R. 3229 / S. 2196. Specifically:

• The report recognizes that CRT wheelchairs include both CRT power wheelchairs and CRT manual wheelchairs.
• The report recognizes that CRT wheelchairs and accessories are required by people with high level disabilities.
• The report recognizes that CRT wheelchairs and accessories are different than standard wheelchairs and accessories. Enclosure 1 in the report highlights the wheelchair differences.
• The report recognizes that CRT accessories are important to ensure the CRT wheelchair can be individually configured to meet the specific needs of a person with a disability.
• The report recognizes that accessory codes contain both CRT and standard products and states they vary in price, characteristics and technology.
• The report recognizes that Congress passed legislation in 2008 to exclude CRT power wheelchairs and accessories from the Competitive Bidding Program.
• The report illustrates the CBP data CMS has for some CRT accessories is from 2009 and is very limited coming from only 9 of 109 bidding areas. That is not sufficient information for adjusting national payment rates.
• The report identifies the significant payment cuts that will result (ranging from 10% to 34%) should CMS inappropriately apply CBP pricing for accessories used with standard wheelchairs to those used with CRT wheelchairs.
• Complex Rehab Technology wheelchair accessories are critical components for Medicare beneficiaries and other people with disabilities. Complex Rehab wheelchairs and related accessories are used by a small population of people with high level disabilities such as ALS, cerebral palsy, multiple sclerosis, muscular dystrophy, spinal cord injury, and traumatic brain injury. Within the Medicare program these individuals represent a small (less than 10% of all Medicare beneficiaries who use wheelchairs) but very vulnerable group of people with significant disabilities.

“We need action from Congress before these cuts limit access and options for some of our most vulnerable patient groups,” said Tom Ryan, president and CEO of AAHomecare.   “What’s more, the negative consequences will not be limited to just the Medicare program, since most other payers follow Medicare policies.  This harmful program could potentially extend to children and adults with disabilities covered by Medicaid and other health insurance plans,” added Ryan. “Passage of H.R. 3229 and S. 2196 will ensure access to this complex rehab equipment for Medicare beneficiaries and other people with disabilities.”

As it stands, H.R. 3229 has 115 cosponsors in the House and S. 2196 currently has 18 cosponsors. For more information about this legislation or the harmful impacts of the competitive bidding program, visit aahomecare.org/issues/power-wheelchairs-mobility.

—Gordon Barnes