Permanent Fix to CRT Accessory Payment Issue

With Congress back in Washington, D.C., for just a short period of time before the November elections, there will be a lame duck session during which Congress will have a small window of opportunity to accomplish a few large and necessary items. The one must-pass piece of legislation will be the federal budget. This window will also be our opportunity to have Congress pass the bills to provide a permanent exemption from competitive bid pricing for accessories used with complex manual and power wheelchairs: S. 2196 and H.R. 3229.

Late last year, in literally the final act before Congress left D.C. on December 18, 2015, the Senate and House passed via expedited “unanimous consent” procedures the Patient Access and Medicare Protection Act (PAMPA) that delayed by 12 months the application of competitive bid prices to accessories used with complex (Group 3) power wheelchairs. Our success last year depended upon the involvement of many in the CRT community, including providers, manufacturers, clinicians and consumers. To be successful this year, we must re-invigorate those efforts to achieve our goal of Congress passing these bills by the end of the year. Following is information to help you communicate to your legislators how important these bills are to your customers and their families, as well as to your business and employees.

We have some new information to tell legislators. Two large national consumer/disability coalitions have publicly urged Congress to pass these bills, and the General Accountability Office (GAO) has issued a report that supports the need for Congress to pass these bills into law. We need the entire CRT community to make sure every Senator and Representative supports these measures as well.

The Consortium for Consumers with Disabilities (CCD), a coalition of more than 100 national disability organizations working to advance national public policy that ensures the self-determination, independence, empowerment, integration and inclusion of children and adults with disabilities in all aspects of society, wrote an August 18 letter to Congress urging Congress to pass these bills:

“The disability community…urges Congress to pass the permanent solution contained in S. 2196/H.R. 3229 by year’s end—this will allow people with significant disabilities to have the access they need to CRT power and manual wheelchair accessories. From the consumer perspective, it is essential that both CRT power and manual accessories are exempted from Competitive Bidding. We believe this is in line with the congressional intent of MIPAA, and that MIPAA only excluded CRT power accessories because CRT manual products were not being competitively bid at that time. Moreover, consumers with disabilities should not face discrimination or disparate treatment when it comes to access to needed accessories simply because they need either a power or a manual wheelchair.”

Similarly, on August 25, the ITEM Coalition officially urged Congress to pass S. 2196 and H.R. 3229. The ITEM Coalition is a national consumer and clinician coalition advocating for access to and coverage of assistive devices and technologies for persons with injuries, illnesses, disabilities and chronic conditions of all ages. The ITEM Coalition wrote:

“[We] strongly urge Congress to pass this year H.R. 3229 and S. 2196, which would permanently exempt Complex Rehab Technology (CRT) wheelchairs and components for people with disabilities and chronic conditions from Medicare’s Competitive Bidding pricing. This important legislation will protect Medicare beneficiary access to both power and manual complex rehab technology, as well as essential components known as wheelchair “accessories.”

“Power and manual CRT wheelchairs and CRT components are essential for a small segment of wheelchair users (about 10 percent of the Medicare population) with significant disabilities such as ALS, cerebral palsy, multiple sclerosis, muscular dystrophy, spinal cord injury and traumatic brain injury. For these wheelchair users, a wheelchair is not complete, usable or even safe without the appropriate complex rehab technology components included.”

As part of the December 2015 PAMPA law, Congress required the GAO to examine Medicare utilization and expenditures for CRT power wheelchairs and accessories. On June 1, the GAO issued this report to Congress—“Medicare: Utilization and Expenditures for Complex Wheelchair Accessories.” The GAO report is significant because it echoes the data we have been presenting Congress to support passage of S. 2196 and H.R. 3229. The GAO report focuses on Medicare utilization and expenditures for CRT group 3 power wheelchairs and the accessories used with them; and how the 2016 competitive bid payment rates for accessories, in particular those furnished in connection with CRT group 3 power wheelchairs, compared to the 2016 unadjusted fee schedule payment rates for the same items. On August 31, the GAO issued additional information for Congress detailing the impact of the July 1 payment cuts on these CRT accessories.

The information in the GAO report validates the data we shared with Congress last year, and supports the need for passage of S. 2196 and H.R. 3229 to prevent CMS from applying bid program pricing to CRT wheelchair accessories. It identifies CRT as including both power wheelchairs and manual wheelchairs, it recognizes that CRT wheelchairs and accessories are required by people with high-level disabilities and it confirms that CRT wheelchairs and accessories are different than standard wheelchairs and accessories. The report recognizes that CRT accessories are important to ensure the 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 illustrates the bid program pricing that Medicare 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.

With all this information, what can you do? It is not hard. Reach out to your federal legislators and urge their support for Congress to pass S. 2196 and H.R. 3229 this year; use the documents available at ncart.us and aahomecare.org, as well as the links to send letters directly to your legislators. Involved with local consumer or consumer advocacy groups? Urge them to do the same.