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A Tumultuous Start to 2016 Shapes Legislative Priorities for Complex Rehab

Posted on in HME Government Issues

2015 ended with high hopes for CRT providers, as a last minute effort to delay cuts to CRT accessories was pushed quickly through Congress. Providers and industry advocates would be given one additional year to make the case that cuts to accessory reimbursement rates for Group 3 power wheelchairs would be harmful to patients, DME businesses and the health system. The accessories include cushions, backs, headrests, power recline and tilt systems and specialty drive controls on complex power wheelchairs.

But, hopes were shattered in early January when CMS announced it would be unable to change its processing system, causing accessories used on Group 3 bases to pay at a lower rate until July. The CMS system flaw is poised to cause billing turmoil for providers who will be reimbursed at rates of 10 to 30 percent less than the 2016 Medicare fee schedule.

The Cascading Effect of Incorrect Billing

“The inability for CMS to administer the payment rates mandated by Congress is a significant failure of our government that has implications at multiple levels,” said Greg Packer, president of U.S. Rehab.

Billing at incorrect rates will cause a cascading effect as secondary insurances and patient co-pays will also bill incorrectly until adjustments can be made in July. Providers will be forced to request a reopening adjustment at the time, causing secondary insurance and patients to kick in more to cover the correct cost of the accessories.

“Requiring patients to pay additional co-pays at a later date will be a nightmare for patients and providers alike,” said Packer. “No patient confronting life-altering mobility events or their families should be forced to jump through these administrative hoops.”

Leaders Team Up to Draft a Plan of Action

Industry leaders met in early February to discuss 2016 legislative priorities. The meeting, which included teams from VGM and NCART, highlighted the CRT accessory issue and the importance of monitoring the financial burden per claim placed on providers. These cost figures are currently being researched and will be available to share with congressional delegations in the near future.

“We’ve already met with House Speaker Paul Ryan to discuss the hardship this CMS error puts on community-based businesses throughout the country,” said Packer. “His response was sympathetic and indicative of strong support for our issue moving forward.”

The alliance determined that an additional delay to competitive bidding reimbursement cuts was not an option. Instead, they would lean on full finalization of a plan that avoids reimbursement cuts. The group also acknowledged the burden of audits on providers but recognized that the audit backlog issue has improved. Despite this, audits will remain a priority in 2016.

For now, advocating for a CMS-recognized separate benefit category for complex rehab technology will remain on the back burner for the year as more pressing battles take priority.

The Small Business Administration is All Ears

Who regulates the regulators? The Small Business Administration, with representatives at the local and national level, has a strong interest in monitoring government regulations that restrict small businesses. “Small business,” as defined by the SBA under the category of “Home Health Care Services,” is determined by revenue receipts of $15 million or less.

The VGM Government team is working with the SBA in regions throughout the country to give providers the opportunity to testify in hearings or round table settings. In a recent West Virginia hearing, a representative from Sen. Joe Manchin’s (D-W.Va.) office read a letter that urged HHS Secretary Sylvia Burwell, whose home state is predominantly rural West Virginia, to delay the pending round of reimbursement cuts scheduled to take effect on July 1. The letter was signed by five Republicans who represent the entirety of the West Virginia delegation.

“Earning the Small Business Administration as an ally to our issues in Washington, D.C., is a big win for the industry and the progress of making our issues heard,” said Tom Powers, director of VGM Government Relations.

Other hearings are scheduled for Utah, Wyoming, North Dakota, South Dakota and Washington, D.C., throughout the spring.

Protecting CRT Depends on the Functional Mobility Assessment

The Functional Mobility Assessment is an outcomes tool used to compare the results of the patient’s satisfaction and mobility capabilities after it is decided new equipment is needed.

“Ultimately, the goal is to collect and track pre- and post-FMA scores on people receiving mobility device interventions, as well as track them over time to make sure the intervention is still working for them,” said Mark Schmeler, Ph.D., OTR/L, ATP, assistant professor at the University of Pittsburgh and developer of the FMA. “We will also collect a de-identified/uniform dataset on users to perform analyses to see what types of devices improve user satisfaction with mobility related activities of daily living (MRADLs) based on factors such as diagnosis, age or living situation.”

U.S. Rehab teamed with the University of Pittsburgh to offer the FMA to CRT providers as a way to track outcomes.

“Tracking patient outcomes, specifically the improvements that result from better quality equipment, will provide proof to decision makers that investing up front in care and equipment will save the system significantly in the long run,” said Packer.

Early FMA results indicate that spinal cord injury, cerebral palsy, multiple sclerosis and stroke represent the majority of conditions requiring attention from CRT providers.

CRT Efforts Will Culminate in Washington, D.C.

NCART is currently planning its annual rally on Capitol Hill. The event will take place on July 11-14, with Capitol Hill visits on July 14. U.S. Rehab strongly encourages as many members as possible to attend in order to speak out about the detriment CMS programs are causing.

More information about the event will be available for U.S. Rehab Members soon. Please watch for it on the U.S. Rehab website and via our newsletter.

 

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