RATC Takes Issue with DME MACs’ New Wheelchair Repair Limits

ARLINGTON, Va. — Saying it threatens the quality of beneficiary care and provider well-being, the American Association for Homecare‘s Rehab and Assistive Technology Council called on the DME MAC medical directors last week to withdraw a new wheelchair repair policy.

The policy, which went into effect April 1, virtually halves Medicare coverage for wheelchair repair labor and payment, according to the RATC.

In comments dated May 11 and signed by AAHomecare President and CEO Tyler Wilson, the organization called the new policy a “radical departure” from traditional Medicare coverage policy for payment of repairs to beneficiary-owned equipment.

The latter establishes coverage for repairs up to the cost of replacing the equipment. The new policy, however, affixes a time limit to repairs; providers are prohibited from billing for service in excess of the policy limits. (See DME MACs Issue Standard Common Repair Allowances, May 2.)

According to a table in the new policy, for instance, providers can now bill only two units of service — with each unit representing 15 minutes of labor — to repair or replace a power wheelchair battery, regardless of how long the repair actually takes. The historical average allowable was four units.

“The problem we have is with the labor reimbursement,” said Tim Pederson, ATS, president and CEO of WestMed Rehab in Rapid City, S.D., and RATC chair. “It’s an unrealistic cap and a major change in policy. We think they have overstepped their authority.”

According to Walt Gorski, AAHomecare vice president of government affairs, “The policy imposes arbitrary restrictions on labor for repairs. There appears to be no basis for these decisions.” He added the restrictions are below providers’ cost, and that imperils quality of care.

“Medicare beneficiaries will be adversely affected because [HME] providers cannot afford to perform repairs in the limited time that the DME MACs have determined to be billable,” the RATC said in its comments. “As a result, many HME providers will be unable to provide the needed items and service to Medicare beneficiaries.”

The comments also questioned the MACs’ assertion that the new policy is a payment policy. It cannot be so, the RATC argued, “because the policy does not in reality establish the ‘fee’ for labor. Rather, it imposes a frequency limitation on coverage for this service. Consequently, we believe that the DME MACs have confused a payment determination with what is in fact a coverage determination.”

The RATC pointed out that CMS has already addressed coverage for repairs, as well as established the payment methodology and the payment amount. “Any additional action by the DME MACs with respect to establishing reimbursement for labor is unnecessary,” the Council maintained.

Beyond that, the policy is “procedurally defective and must be withdrawn,” the RATC said, because there was no notice and no opportunity for comment.

“The DME MACs can do payment policy, but they cannot do coverage determination as they did it without notice and comment,” said Gorski.

By not getting input, the RATC said, the DME MACs imposed unrealistic time limitations on providers.

“The DME MACs imposed frequency limits on Medicare coverage for labor without any consultation with providers. As a result, the new policy grossly underestimates the time involved in making a repair,” the comments note. “We request that the DME MACs withdraw the policy and adhere to the repair policy specified under the [Medicare benefit and claims processing] manuals.”

Should the MACs elect not to rescind the policy, the association said they should at least withdraw the policy and issue a proposed policy with an appropriate comment period.

“These are very concerning and distressing changes,” Gorski said. “This is a quality-of-care issue, a beneficiary issue. It’s the beneficiaries who suffer. We hope to change the minds of the medical directors in order to have this policy changed.”