NCART Cautions States On PMD Fee Schedule

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

Sent in December, the report was accompanied by a letter copied to each state’s governor. The letter explains 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 Hildebrandt said 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,” Hildebrandt 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.