by Seth Johnson

Congress is currently on its annual summer recess. This provides a great opportunity to schedule a local office meeting or, better yet, a site visit to your company to educate them on the challenges your company is having providing products/services to beneficiaries.

Votes are expected on Medicare legislation throughout the fall, and priority issues include: legislation to modify CMS's plans to apply bid rates in rural areas; legislation to stop the application of bid rates to exempt complex rehab wheelchair accessories; audit reform legislation; and separate recognition for complex rehab technology. Here is a guide to assist in your advocacy efforts.

Application of Competitive Bidding Rates in Non-Bid Areas

The latest industry draft of a legislative proposal to provide some relief to this application would:

  • Establish a 30 percent adjustment to help compensate for the increased costs suppliers incur in non-CBAs to be applied to average regional, single payment amounts as determined by the methodology in the Final Rule.
  • Provide a four-year phase-in of the national price adjustments to the DMEPOS fee schedule.
  • Establish in statute the bid limit ceiling for competitive bid contracts that begin on or after January 1, 2017, at the unadjusted fee schedule payment rates as of January 1, 2015.

Application of CB Rates to Exempt CRT Accessories

While Medicare has the authority to roll out competitive bid pricing in non-bid areas, they do not have the authority to apply pricing for exempt items.

A December 2014 CMS FAQ document indicates Medicare intends to apply CB pricing information obtained through bids on standard wheelchair accessories to reduce payments on complex rehab items. Such application of bid pricing goes against the statutory language in the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, which specifically exempted wheelchair accessories from CB when used on a complex rehab wheelchair base.

NCART, AAHomecare and many complex rehab stakeholders were successful in getting more than 100 legislators to send a strong bipartisan \'93Dear Colleague\'94 letter to the CMS Administrator expressing concerns, along with a request to continue to pay for CRT accessories at the Medicare fee schedule amount. Legislative language has been developed and the goal is to include it in the next moving Medicare vehicle.

Audit Reform

At press time, Representative Renee Ellmers (R-NC) and Representative Tammy Duckworth (D-IL) were planning to introduce DME Audit Reform legislation to improve the audit process. Specifically the bill: requires Medicare contractor transparency and reporting; restores use of clinical inference and clinical judgment when evaluating audits; limits documentation review periods; requires DME MACs to conduct outreach and education programs for suppliers, physicians and referral sources to lower error rates; and provides incentives for DMEPOS suppliers who have low error rates.

Separate Recognition of CRT

The "Ensuring Access to Quality Complex Rehab Technology Act of 2013", H.R. 1516 and S.1013 have gained significant bipartisan support during the last few months. As of this writing, H.R. 1516 has 116 cosponsors, and 9 Senate members have signed on to S.1013.

The week of August 17th is National CRT Week. It is important that all CRT providers contact their Representatives and Senators to schedule meetings then. Legislators will be back in their districts/states in August, but schedules fill up quickly so don't delay. Call to schedule a site visit or meeting today! The latest position papers and supporting materials on the priority issues can be found at and