Changes Continue, but is it Enough?
Are new power mobility fee revisions issued by CMS a cause for celebration? It depends on who you ask. Word from the Power Mobility Coalition (PMC) is that cuts remain unacceptable. “Unfortunately, this new reimbursement still establishes drastic and dramatic cuts in the PMD benefit and fails to address concerns regarding beneficiary access to these much needed products,” said Eric Sokol, director of the PMC, Washington, DC. “While CMS did raise payment levels for some PMDs, reimbursement for the most often prescribed power wheelchairs is still 15% to 35% less than current allowables.”

According to Seth Johnson, director of government affairs for Pride Mobility, Exeter, Pa, the biggest change issued after the new fees went out (at press time) is that CMS will allow providers to bill separately for the expandable controller provided on Group 3 multiple power wheelchairs, and also Group 4 and 5 multiple power option wheelchairs. CMS also further revised the payment rates for Groups K0857 and K0859. “We are continuing to work with CMS to identify the areas within the fee schedule that require additional refinements,” said Johnson, “and we are pleased that CMS has indicated any additional changes made to the fee schedules will be retroactive to November 15, 2006.”

Industry giants such as Invacare were cautiously upbeat while calling for better documentation standards. “The October 2 fees illustrate the fatal flaws inherent in CMS using the gap-fill method to establish new fees for any products,” said A. Malachi Mixon III, Invacare’s chairman and CEO. “We look forward to working with CMS to develop a new method to establish fees for new codes that will ensure appropriate and continuing beneficiary access. We also look forward to working with CMS to revise their documentation standards, which currently require providers to obtain onerous levels of physician documentation for power wheelchair reimbursement.”

According to the Congressional Quarterly (CQ), CMS officials said new rates reflect revised data the agency used to determine the payment amounts. The CQ report goes on to say: “New payment rates for complex rehabilitation, or ‘Group 3’ power mobility devices used by the severely disabled, will increase between $1,000 and $1,700, a significant increase over the payment rates announced in October.”

At Sunrise Medical, Longmont, Colo, officials praised CMS for assuring that they will continue to analyze data provided by manufacturers over the next couple of weeks and make fee schedule adjustments where needed.

“This is a demonstration that the rehab industry can unite and work together to have an effective and constructive dialogue with CMS,” said Rita Hostak, president of NCART (National Coalition for Assistive and Rehab Technology) and vice president of government relations for Sunrise Medical. “If there had not been an adjustment of this type for multi-power option bases, then we would have experienced disastrous and long-lasting negative impacts on the entire rehab community—end users, clinicians, referral sources, dealer providers, manufacturers, everyone. This is a strong signal that when we work together—under the auspices of NCART—we can present credible and defensible positions. This effort demonstrates not only that our voices will be heard in Washington, but also that we can achieve positive outcomes that are fair for all parties.”

Even with the largely conciliatory tone of Sunrise and Invacare, concerns remain. “While there are significant improvements with the November 9, 2006, fees, there remain issues with several of the codes,” according to Invacare’s official response via press release. “For example, within Group 3 products, payment levels for products with single power and multiple power options will be paid at virtually the same rate. This is despite the fact that the Group 3 multiple power option products must include more expensive expandable electronics. In addition, there remain serious payment reductions on Group 2 consumer power products.”

On the consumer side, Tara N. Raeber, advocacy specialist for the National MS Society’s Public Policy Office, called the payment increases for Group 3 chairs “a victory for the disability community,” which fought to increase the payment rates.

CMS said that the rate for the most commonly provided standard geriatric mobility chair (Group 2) will increase by $301 over the fee schedule announced in October. Sokol says the revised $300 increase in payment still translates to a 25% cut from current levels. And according to CMS, 90% of Medicare spending for PMDs is on category 2 chairs. “While this slight bump in price for category 2 PMDs is welcomed,” says Sokol, “the revision does little to alleviate concerns that steep price reductions will force suppliers to close their doors and beneficiaries to have few, if any options, for quality equipment and service.”

CMS Names Deemed Accreditors
CMS ended months of speculation when they announced the names of 11 national accreditation organizations eligible to accredit DMEPOS suppliers. These accreditors are now fully capable of helping providers meet quality standards under Medicare Part B.

• Accreditation Commission for Healthcare Inc
• American Board for Certification in Orthotics and Prosthetics Inc
• Board for Orthotist/Prosthetist Certification
• Board of Certification in Pedorthics
• Commission on Accreditation of Rehabilitation Facilities
• Community Health Accreditation Program
• Healthcare Quality Association on Accreditation
• Joint Commission on Accreditation of Healthcare Organizations
• National Association of Boards of Pharmacy
• National Board of Accreditation for Orthotic Suppliers
• The Compliance Team Inc

CMS will instruct accrediting organizations to focus first on suppliers in the initial group of metropolitan statistical areas MSAs chosen for the competitive bidding program. These accreditation organizations are authorized to accredit all major supplier types, and most will be able to accredit both national and local suppliers, as well as mail order companies.

Now that accreditors and final standards are set, more changes are in store. “Right now we are all awaiting the listing for the 10 MSAs and the products to first be competitively bid because CMS has indicated that is where we must perform our prioritization,” says MaryAnn Popovich, executive director of JCAHO’s homecare accreditation, Oakbrook Terrace, III. “I would assume that we are also going to see more appendices as more products get defined for competitive bidding.”  

For newly deemed accreditors, it’s time to get to work. “I see this as a victory for small business. As the only privately owned, for profit, small business accrediting body, we have created a true alternative for small business providers,” says Sandra C. Canally, RN, president of The Compliance Team Inc, Spring House, Pa. “We are very excited to help these providers. The phones are ringing off the hook. People we met years ago, who have waited on the fence to make their choice, are now choosing us.