Home Health & Hospice Week

Wheelchair suppliers push for more eleventh-hour changes.

Suppliers of power mobility devices will still see cuts in Medicare payments for their wares starting Nov. 15--but not at the levels originally announced Oct. 2.

On Nov. 9, the Centers for Medicare & Medicaid Services announced fee schedule increases for some types of PMDs.

Responding to comments from industry stakeholders and advocates for the disabled, the agency recalculated payments for certain codes in the fee schedule. The adjustments will have an "upward effect" on pricing, said CMS' Laurence Wilson during an audioconference for disability advocates.

The codes' fee schedule originally called for rate cuts of up to 44 percent for some devices (see Eli's HCW, Vol. XV, No. 37)

Last minute: Even though the implementation date was nigh, suppliers had gotten up their hopes for an increase. That's because CMS said in a Nov. 8 Open Door Forum that it was still reviewing the comments it received on the codes and still could make changes. "Stay tuned," CMS' Joel Kaiser told participants.

Prices for category 3 (complex rehabilitation) PMDs--used by the most severely disabled--will increase the most, notes Sharon Hildebrandt of the National Coalition for Assistive & Rehab Technology.

Of the 64 PMD codes, some were raised "well over $1,000," Wilson said.

But suppliers counter that although the increases are welcome, there's more work to be done.

"Even with the increases, the rates will not be viable for some suppliers," cautions Eric Sokol of the Power Mobility Coalition. "We are still talking about an overall cut of 27 percent for category 2."

Expect Battle To Continue

Suppliers have fought hard for the concessions won so far, says Hildebrandt.

Background: After the release of the Oct. 2 fee schedule, manufacturers, suppliers, clinicians and consumer rights advocates rallied immediately to increase payments, charging that the rates would put suppliers out of business and hurt patient access to needed supplies.

A group of 44 bipartisan House members wrote to the Department of Health and Human Services Oct. 31 asking for a delay in implementation of the rates.

Double whammy: The cuts come at an already tough time for suppliers, who are faced with the costs of accreditation, related capital improvements needed to secure accreditation and increasingly stringent documentation requirements, Sokol notes.

The PMC, NCART and others are calling on CMS to decrease the cuts even further, challenging the methodology by which the feds reached the amounts listed in the original fee schedule.

In the teleconference, CMS said that it examined new manufacturer data; added in the cost of bundled accessories, such as seat belts and foot plates; raised suggested retail prices; reconfigured its formula to ensure that inflation factors were applied uniformly; and ensured that heavier-weight power wheelchairs were not priced lower than those of standard weight because of a lack of data, according to Wilson.

"CMS has promised to show us its calculations," reports Sokol. CMS has also invited suppliers to submit validated figures that support further increases in the fee schedule, he says.

Hardest hit: If the current fee schedule sticks, rural suppliers will suffer the most, predicts Sokol.

"If you're out there trying to serve Big Sky Country, something will have to give," he says. "You can't make it on those rates and the kind of volume that rural providers have." v

Note: Changes to the PMD fee schedule are at www.cms.hhs.gov/DMEPOSFeeSched/01a_Power_Mobility_Devices.asp#TopOfPage.