Home Health & Hospice Week

Stakeholders could turn to Congress, state lawmakers.

With Medicare paying considerably less for power wheelchairs, and many Medicaid programs ready to do the same, suppliers are strategizing about how to protect patients--and profit margins.

"We are asking suppliers to keep careful track of how the payment cuts are affecting business," Eric Sokol of the Power Mobility Coalition tells Eli.

The goal: Sokol and other stakeholders hope that, armed with data, they can persuade Congress to weigh the feds' cost-saving measures with concerns about patient access.

Background: Since Nov. 15 Medicare pays suppliers considerably less for power mobility devices. The cuts come as a result of the program's adoption of an expanded new set of billing codes and the corresponding fee schedule.

Since issuing the new fee schedule on Oct. 2, the Centers for Medicare & Medicaid Services has revised it twice, adjusting upward the rates paid for certain classes of power mobility devices (see Eli's HCW, Vol. XV, No. 41 and Vol. XV, No. 45).

CMS increased payments for almost all PMD codes, reports the National Association for Home Care & Hospice, in its summary of the latest round of revisions issued on Dec. 12. Still, suppliers are likely to struggle moving forward--particularly in rural areas, notes Sokol.

Do this: In addition to tracking employee layoffs, suppliers should record how the cuts are affecting service areas and product offerings, coaches Sokol. Once you've collected the data, work with industry groups to convey your concerns to policymakers.

Keep Your Eye on the States

Suppliers and patient advocates are also growing increasingly concerned about the effect the new PMD codes will have on Medicaid payments.

Earlier this month, the National Coalition for Assistive and Rehab Technology sent a cautionary report to state Medicaid directors to curb cuts as Medicaid adopts Medicare's new power mobility device fee schedule.

The report, "Adopting Medicare Power Mobility Policies Will Impact the Provision of Appropriate Client Services," is NCART's attempt to work with states as they implement the 64 new Healthcare Common Procedure Coding System (HCPCS) codes for power mobility, says Sharon Hildebrandt, the group's executive director.

The report reviews the various Medicare PMD policies with practical data to educate state policymakers. Pricing and coverage policies are set to "dramatically impact access" to appropriate technology for Medicaid recipients if caution is not used in adopting these Medicare policies.

Access denied? NCART is also concerned that Medicare's new rules include new qualification standards that make it harder for beneficiaries to qualify for a mobility device, reports Hildebrandt. If Medicaid adopts similar new standards, many more patients who need PMDs won't be served, she says.