We have been fielding some questions as to why S-2425 does not include accessories used with Complex Manual wheelchairs. To help you respond to those questions should they arise, here is a summary of the background and related talking points.
1) When HR-3229/S-2196 was introduced, the language was specifically written to prevent CMS from applying competitive bid pricing to accessories used on EITHER Complex Power and Complex Manual That was our objective throughout the year.
2) We all know the multitude points that were the basis for HR-3229/S-2196. In addition to the MIPPA “violation,” we felt that CMS was going outside the authority they were given to use competitive bid information to expand payment amounts for “competitive bid items” to non-bid areas. The fact is Complex accessories had NOT been competitively bid so CMS’ expansion of payment amounts should not apply to Complex accessories.
3) MIPPA Language Issue: The language in the 2008 MIPPA legislation only specified an exemption from competitive bidding to “Complex Power Wheelchairs (group 3 and above) and related accessories.” This was because at that time Complex Power was the only CRT item being competitively bid and so Congress limited the language to that. This year whenever the MIPPA question came up in Congressional discussions (“MIPPA only says complex power accessories and you want both Complex Power and Complex Manual accessories exempted?”), we would explain that:
– The “intent” of Congress within MIPPA was to protect CRT and the reason MIPPA only said Complex Power was because that was all that was being included at that time
– CMS correctly has followed the intent of MIPPA and has NOT included accessories used with Complex Manual wheelchairs for the past 7 years
– It makes no sense and would be discriminatory for Congress to protect only people who use Complex Power but NOT protect those who use Complex Manual
– From a CBO financial score perspective, the majority of the dollars spent relate to accessories used with Complex Power so including accessories used with Complex Manual does not have a significant cost.
4) We had to accept a less than complete solution NOW in order to allow us more time to push for permanent fixes. Unfortunately on December 12th, at the eleventh hour, our Congressional champions notified us that the only thing that would get support for passage before year end was:
– a one year delay with a GAO study and
– the delay will only apply to accessories used with Group 3 Complex Power. Some offices remained hung up on the fact that MIPPA only said Complex Power and were not willing to extend to Complex Manual.
This was an eleventh hour take-it or leave-it offer and we agreed to accept it (not that we had a choice) given:
– We estimated over 80% of the cuts related to Complex Power wheelchair accessories
– The delay would allow us to address more permanent solutions in 2016.
5) Rough numbers: when it comes to Medicare Complex Wheelchairs there are about 50% Complex Manual and 50% Complex Power chairs paid for every year. As to accessories, of the 171 codes: 61 or 36% are for power-only; 37 or 22% are for manual-only; and 73 or 43% can be used on both. As to the dollars spent annually our estimates are: 82% for power-only codes; 3% for manual-only codes; and 15% for codes used on both.As to the impact of the cuts our estimates are: 70% of the CRT cuts would have been to power-only codes; 5% would have been to manual-only codes; and 25% would have been to codes used on both. We think this delayed at least 80% of the cuts. This is not what are our ultimate goal was, but it protected the majority of the impact and gives us something to build on next year. We will be picking this up as part our discussions on permanent changes in 2016.
More information on the reimbursement cuts and next year’s legislative goals will be released in 2016.