In A Last Minute Effort, Congress Delays Complex Rehab Wheelchair Accessory Cuts for Group 3 Power Wheelchairs

Posted on in HME Government Issues


Congress wrapped up last minute business before the holiday recess on Friday. The final legislation passed this year was S. 2425, the “Patient Access and Medicare Protection Act.” This act included a one-year delay in the application of competitive bid rates to complex rehab technology (CRT) accessories used with Group 3 power wheelchairs. The delay is not associated with any other accessories on any other bases.

U.S. Rehab wants to thank all of our members who met the call to action. We asked you through numerous emails and phone calls to help with this fight, and you rose to the occasion to make our industry’s voice heard. We do not have the financial power as some groups who lobby Congress, but we do have a cause that is worth the fight.

The complex rehab industry took a partial sigh of relief as this buys more time to completely rescind the misapplication of competitive bid rates to complex rehab technology (CRT) wheelchair accessories. CMS has taken a strategy to force all rehab users to live their lives with substandard rehab products.

The passage of this act means that people with disabilities will retain access to medically necessary accessories on Group 3 power wheelchairs, such as cushions, backs, headrests, power recline and tilt systems, and specialty drive controls on complex power wheelchairs.

While the full text of H.R. 3229/S. 2196 was not passed, the one-year extension tells us that legislators have an awareness and understanding of our issue. We have laid the groundwork for our continued work in 2016. We will continue to fight the application of competitive bid rates to accessories and work to establish needed improvements for CRT reimbursement in Medicare and other health insurance plans. NCART, AAHomecare, NRRTS, United Spinal and many others have taken this as the primary fight for our industry. It is this focus that will help us push a full fix through in 2016.

The Lead Up to the Extension

The one-year extension did not come without a tireless effort from VGM, U.S. Rehab, providers, manufacturers and industry groups. CMS released Final Rule 1614-F in November 2014 indicating that CRT accessories would be included in the competitive bid program effective January 1, 2016. This would cause a 30-50 percent cut in reimbursement rates for accessories on the inception of this rule. U.S. Rehab and other industry groups gave comments to the rule change as it clearly violated the intent of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). CMS did nothing in response.

With this announcement, the rehab industry pulled together and shifted our focus from separate benefit legislation (H.R. 1516/S. 1013) to saving CRT accessories from competitive bid pricing.

In April 2015, a Dear Colleague letter was introduced by six representatives, Bill Johnson (R-OH), Diana DeGette (D-CO), Dave Loebsack (D-IA), Mike Kelly (R-PA), John Larson (D-CT), and Devin Nunes (R-CA) asking CMS to review their decision to apply competitive bid rates to complex rehab accessories. The letter received bipartisan support by 101 representatives. However, CMS refused the congressional request.

As the Dear Colleague letter to CMS was unable to change the December 2014 ruling, Rep. Lee Zeldin (R-NY) introduced H.R. 3229, a bill that would make a technical correction to exclude complex rehabilitative accessories, cushions and backs from the competitive bid program on July 28, 2015. The introduction of this bill was a crucial step forward as the House letter to CMS was unable to solve the issue. VGM and U.S. Rehab actively sought for a champion in the Senate to introduce a companion bill.

On August 11, 2015, a Senate bipartisan Dear Colleague letter was signed by 22 senators asking CMS to review their decision to apply competitive bid rates to accessories on complex rehab wheelchairs. Similar to the House Dear Colleague letter, CMS refused to act on the Senate request. Since both requests for CMS to review their policy were ignored, the only way to stop the application of competitive bid rates to complex rehab wheelchair accessories was through legislative action.

While we were pushing representatives to sign on to H.R. 3229 and for a Senate companion bill to be introduced, the Protect My Independence campaign was launched on September 23, 2015 through the efforts of VGM and key industry and manufacturer partners. This petition was created through the We the People platform. Once this type of petition reaches 100,000 signatures, it gains the attention of White House staff and requires a response from President Obama. The petition explained how the proposed cuts will devastate access to complex rehab accessories for people with disabilities across the United States. While the petition only received approximately 28,000 signatures, we were made aware that the White House was knowledgeable of the petition and our issue.

On October 23, 2015, S. 2196 was introduced in the Senate as a companion to H.R. 3229. To date, the bill has 16 cosponsors.

Providers Take a Stand for CRT

During August to November, Tom Powers and John Gallagher from VGM Government Relations had several meetings with members and key congressional leaders to help further our cause. Two meetings had substantial impact in the future of our legislation. On November 12, 2015, Powers and Washington providers met with Rep. Cathy McMorris Rogers (R-WA) to explain the CRT accessory issue and retaining access to medical equipment and supplies. We thank Don Whitney of Inland Medical and Rehab, Chuck Vetsch of Keeler’s Medical Supply and other Washington providers for making this connection. Vetsch also met with Rep. Newhouse (R-WA) and Sen. Murray (D-WA), preparing for the next steps for rural rollout and CRT legislation.

On November 24, 2015, Powers, Doug Coleman from Major Medical Supply, Jody Wright from Rocky Mountain Medical Equipment, and other CAMES members met with Rep. Diana DeGette (D-CO) to convey the importance of rural rollout and CRT legislation. Both of these legislators became key champions with CRT and rural rollout legislation. There were many other meetings that led to this delay and we thank each of our members for their support.

Legislative action gained speed beginning in November. On November 17, 2015, House Ways and Means Committee Chairman Kevin Brady (R-TX) and ranking member Sander M. Levin (D-MI) told CMS that the application of competitive bid rates to CRT power accessories may result in unacceptable access issues for beneficiaries. This letter also gained the attention of Bloomberg BNA, a major publication on Capitol Hill.

Greg Packer, Powers and Gallagher hit the road again the week after Thanksgiving and visited 52 legislators in two and a half days in Washington, D.C.  The main goal of the meetings was to gather support for S. 2312 to mitigate the nationwide rollout of competitive bidding and also work to gain more signatures and support for H.R. 3229 and S. 2196. Due to the industry’s work on the hill, H.R. 3229 had 77 co-sponsors and S. 2196 had 14 co-sponsors as of December 11, 2015. We also had hope that the legislation would be included on the Omnibus bill.

We learned on December 17, 2015 that the CRT legislation and the rural rollout bill were not included on Omnibus bill. However, S. 2425, the “Patient Access and Medicare Protection Act” was introduced in the Senate under the “hotline” process. Senators had 24 hours to object to the bill. As there were no objections, the bill moved onto the House for passage. The legislation was passed in the House and moved onto the President to be signed into law. The legislation included only accessories furnished in connection with Group 3 complex rehab power wheelchairs due to the lobbying from CMS. CMS misrepresented this issue, and we are concerned with their actions.

It took us a year of continued hard work from the industry to get us where we are at today. U.S. Rehab wants to thank Don Clayback of NCART and the NCART team for leading the charge and pulling the industry together in this time of great need.

“U.S. Rehab was involved from the beginning and engaged their membership on a grassroots level plus Greg Packer and Tom Powers spent time in D.C. delivering the message personally,” said Clayback.

Looking Forward

VGM and U.S. Rehab will continue to work with NCART in 2016 to make further advancements in protecting and improving access to CRT and the related supporting services. We understand the importance of this medically necessary equipment to children and adults who depend on it to have healthier days and maintain quality of life.

“It’s always relieving when you have a win, but this is only leading to even greater efforts to come,” said Greg Packer, president of U.S. Rehab. “Providers, manufacturers and patient groups will need to stay strong and stay united to pass a long-term solution next year.”

We were able to continue relationships with members of Congress and build new ones over the past year. We will use these relationships to have a long-term solution put in place.

Stay tuned and watch your inbox for what’s next in 2016. The fight is not over yet!