CMS Exempts CRT Accessories from Bidding-Derived Pricing

Concerted advocacy push combined with sympathetic agency leadership and lawmaker involvement pays off with protection for CRT providers, patients.

In news that has relieved Complex Rehab Technology (CRT) providers and patients alike, CMS has exempted accessories for powered CRT mobility devices from the application of competitive bidding-derived rates, as it had previously been doing for the national expansion of competitive bidding.

The news comes after a frustrating fight by industry advocates to protect CRT accessories from the application of bidding rates, either directly or through rate structures derived from the bidding program.

Congress’s 2008 passage of Medicare Improvements for Patients and Providers Act (MIPPA) was supposed to protect CRT from competitive bidding. CRT was carved out of the program, and the lawmakers that passed it assumed that included all CRT items.

When CMS decided during the 2016 national expansion of competitive bidding that MIPPA didn’t apply to accessories, Congress followed with the CURES Act, which delayed the application of bidding-derived until July 1. The announcement from CMS extends that provision indefinitely.

“CMS is issuing a new policy on how adjustments to the fee schedule based on information from competitive bidding programs apply to wheelchair accessories and back and seat cushions used with group 3 complex rehabilitative power wheelchairs,” the announcement stated. “Section 16005 of the 21st Century Cures Act currently allows higher payments for these items but is set to expire after June 30, 2017. By continuing these higher payments, this new action will help to protect access to complex rehabilitative power wheelchair accessories on which people with significant disabilities depend.”

That announcement is a “big win” for CRT providers, according to American Association for Homecare President and CEO Tom Ryan.

“CMS’ action ensures that individuals with significant disabilities will continue to have access to specialized technology that they depend on, which will also be welcome news for caregivers and medical professionals who support these individuals,” he said.

Ryan lauded HME providers, patients and advocacy groups for the hard work in convincing CMS that the change was needed.

“I’m especially appreciative of the terrific support that the National Coalition for Assistive and Rehab Technology, United Spinal Association and the ITEM Coalition lent to this effort, as well as the strong engagement from AAHomecare member companies that manufacture and provide mobility products,” he said. “When the HME industry and patient groups are strongly united on public policy initiatives, it sends a powerful message to regulatory agencies and Capitol Hill.”

Ryan also credited HHS Secretary Tom Price and CMS Administrator Seema Verda, as well as lawmakers, for recognizing the seriousness of the issue. The House sign-on letter that attracted more than 150 signatures “helped send a strong message” that Congress considered protecting the items a priority.

“It’s clear that the new leadership at HHS and CMS understand the effectiveness of highly specialized CRT products and other essential HME products in meeting patient needs and reducing hospital stays and other costly clinical interventions,” he remarked. “We also appreciate the sustained advocacy of Senators Bob Casey (D-Pa.) and Rob Portman (R-Ohio), as well as Reps. Lee Zeldin (R-N.Y.) and John Larson (D-Conn.), who both helped secure the earlier legislative delays to bidding-derived cuts and also led Congressional efforts to secure a long-term solution on CRT.”


About the Author

David Kopf is the Editor of HME Business.

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