Congressional Legislation Introduced to Help Complex Rehab and Rural Providers
by Seth Johnson

Congress introduced two bills to address concerns with CMS's plans to apply competitive bid (CB) rates to statutorily exempt complex rehab technology (CRT) wheelchair accessories and to apply bid rates in non-bid areas. Absent passage of the legislation, Medicare payments to providers will be cut significantly for CRT wheelchair accessories and the DME items included in competitive bidding. Outreach and advocacy efforts with your federal legislators are needed to help strengthen support for passage of the bills.

The CMS proposals were included in a Final Rule (1614-F) last November, which contains provisions relating to the DME Competitive Bidding (CB) program and how CMS plans to roll out competitive bid pricing in non-bid areas. A subsequent December Frequently Asked Questions (FAQ) document indicated that beginning in 2016, Medicare also intends to apply CB rates for standard wheelchair accessories to reduce payment amounts for complex rehab wheelchair accessories, which were specifically exempt by Congress from being included in the CB program.

It was not all that long ago that many providers believed they were unaffected by the program since it was originally rolled out in only nine competitive bidding areas (CBAs). That has clearly changed. While Medicare has authority to roll out competitive bid pricing in non-bid areas, they do not have the authority to roll out the pricing for items specifically exempt from the bid program. We are all affected by competitive bidding and need to be unified in our messaging to legislators in the coming weeks and months in order to secure better outcomes prior to implementation of the new lower rates in January 2016.

Application of Bid Rates to Complex Rehab items

The FAQ document stated that CMS intends to apply CB pricing information obtained through bids on 171 standard wheelchair accessories to reduce payments on complex rehab items. These items include complex head support systems, seat/back cushions, tilt/recline systems, specialty controls, etc. 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. For the last six years, Medicare has paid for these items at the traditional fee schedule amount when provided on a complex rehab wheelchair base due to the specific language in the law.

On July 27, Representative Lee Zeldin (R-NY) introduced legislation, HR 3229, to further clarify the non-application of Medicare competitive bidding rates to complex rehabilitative wheelchairs and accessories. This bill was introduced at the recommendation of congressional leadership and key committee members on how best to reiterate the congressional intent of MIPPA and protect these items from the application of bid rates.

More than 100 Representatives expressed their concern for CMS's plan in a "Dear Colleague" letter to the agency and HR 3229 continues to gain congressional cosponsors. NCART and AAHomecare are actively working with both CMS and Congress to rescind the FAQ policy change so CRT items continue to be paid at the traditional Medicare fee schedule amounts and not ones based on CB pricing.

More than 25 Senators have also formally weighed in with CMS Acting Administrator Andy Slavitt via letter or phone call to express concerns with the agency\'92s plans to apply bid rates to CRT wheelchair items.

Application of Bid Rates in Non-Bid Areas

CMS's Final Rule (1614-F) issued last November also outlines how Medicare plans to apply competitive bidding rates in non-competitive bid areas. While providers in these areas will not be required to submit bids, CMS will use single payment amounts from other nearby CBAs to set the rates for these non-bid areas, including areas that Medicare considers to be rural.

The new regional pricing will be phased in beginning on January 1, 2016. Payment rates for all affected items will be set at 50 percent of the adjusted fee schedule amount versus the current rate. For example, if the current fee schedule amount is $100 and the adjusted rate is $75, the payment amount for that item on January 1 will be $87.50. Beginning July 1, 2016, the rates are reduced to 100 percent of the adjusted fee schedule amount, or $75 in the example above. In addition, future rounds of bidding would use these adjusted rates as the new bid limit ceilings.

At press time, Representative Tom Price (R-GA) and Senator John Thune (R-SD) were completing work on a proposal to help protect non-bid area providers from the drastic cuts that will otherwise result on January 1, 2016. This legislation will provide specific direction to CMS as to how to apply bid rates in these areas. The legislative proposal would do the following for all DMEPOS providers in non-competitive bidding areas:

  • Establish a 30 percent adjustment to address increased costs suppliers incur in non-competitive bidding areas to be applied to the average regional single payment amount as determined by the methodology set forth in 42 C.F.R. 414.210(g) (79 Fed. Reg. 66120 (November 6, 2014)), as well as an update mechanism.
  • Provide for a four-year phase-in of the national price adjustments to the DMEPOS fee schedule set forth in 42 C.F.R. 414.210(g) (79 Fed. Reg. 66120 (November 6, 2014)) when implementing them.
  • 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.

The latest on the bill and advocacy materials necessary to strengthen support can be found at

Support is already building for these proposals and opportunities to advance them through Congress have been identified. However, your legislators need to hear from you regarding the impact these changes will have on your company and the ability to provide quality products and services to Medicare beneficiaries. After all, you and the beneficiaries you serve are constituents and are the voices that legislators place a great deal of importance on when evaluating these legislative proposals.