Medicare’s Reclassification of Certain DME from Routinely Purchased to Capped Rental

Last Friday, CMS published the final rule CMS-1526-F that includes reclassification of

certain DME items from the routinely purchased payment category to the capped rental

payment category.

This includes tilt-in-space manual wheelchairs, pediatric manual wheelchairs and

manual wheelchair power-assists. By reclassifying these items, CMS will severely limit access to

Medicare beneficiaries who truly need the complex rehab seating and positioning that can only

be provided with this type of equipment. Suppliers will not be prepared to provide this

equipment to individuals on a capped rental basis because of the high level of expertise

required. CMS itself requires an evaluation by an ATP and a therapist for this level of need,

which is complex and typically lifetime. This is not a product that should be considered as a

capped rental.

U.S. Rehab, represents more than 1,200 member locations, and we were one of 172

organizations and individuals who submitted comments about CMS’s proposal several months

ago. For CMS to completely ignore any guidance from the sector that will be forced to say no

to Medicare beneficiaries because of payment structure flaws is very disturbing. It’s also

disturbing that the final rule was issued at 5:30 p.m. on Friday just before the week of

Thanksgiving when all governmental officials will be on break from Washington, DC.

The way to address this ruling now is through legislation. The bill to separate complex

rehab technology within the DMEPOS benefit category does just that. This law would clearly

define CRT products and protect them from capped rental issues. It is very important that you

take the time to contact your congressional offices and express your support for the Ensuring

Access to Complex Rehabilitation Technology Act (H.R. 942 and S. 948).

Please take the time to read and understand what CMS has done to the process of

providing this complex rehab equipment that is individually considered for each person. They

have re-categorized this equipment as commodities and put the individual’s health and wellbeing

at risk. They have also affected the scope and practice of the ATP, PT and OT

communities because potentially needed equipment will be difficult, if not impossible, to

provide as capped rental items.

You can find a copy of the CMS-1526-F on our website, along with a chart of affected

products, including complex rehab products that will now be capped rental and no longer

purchased items.

U.S. Rehab will continue our efforts to make everyone aware of the effect this will have

on patient access. We urge you to take the time to contact your congressional members and

discuss your support for the Separate Benefit Category for CRT.

Wheelchair Related Codes Reclassified to Capped Rental Per CMS.pdf

Final Capped Rental Rule- CMS-1526-F DME Provisions.pdf