Author Archives: Mickae Lee

Medicare Call Re Prior Authorization for Certain Group 3 Wheelchairs

March 15, 2017

CMS is holding a Special Open Door Forum call tomorrow, March 16, from 2:00 PM to 3:30 PM ET regarding the new Medicare Prior Authorization (PA) requirement for two CRT Group 3 Power Wheelchair codes.

This PA requirement goes into effect in the states of Illinois, Missouri, New York, and West Virginia for dates of service of March 20 or after.  The PA requirement will expand nationwide in July.

The two codes impacted are K0856 (Group 3 Standard Power Wheelchair with Single Power Option) and K0861 (Group 3 Standard Power Wheelchair with Multi Power Option).

You can find the full announcement with additional call details here.  The dial in number is 1-800-837-1935 and the Conference ID # is 85144406.

The call will be recorded by CMS for later playback.  Details will be posted at the CMS Open Door Forum website.

April CRT Leadership and Advocacy Conference

February 3, 2017

CRT Stakeholders and Friends,

It’s time to sign up for this year’s National CRT Leadership and Advocacy Conference put on by NCART and NRRTS! We’re meeting on April 26 and 27, 2017 at the Hyatt Regency Crystal City in Arlington, Virginia. You’re invited to join other CRT stakeholders for a great program of education, advocacy, and networking.

A major part of the conference is visiting Members of Congress to push for passage of our “CRT Wheelchair Accessories” and our “CRT Separate Benefit Category” legislation. We built good momentum last year thanks to everyone’s efforts. But this year’s visits are critical to getting passage of permanent fixes and improvements.

We need as many CRT advocates as we can get taking the CRT message directly to Congress. To enable greater attendance, and recognizing the demands on people’s time and dollars, we have condensed this year’s conference program to two days and reduced the conference fee to only $199.

Attendees will benefit from industry-driven topics, unique networking opportunities, regulatory and legislative updates, and Capitol Hill appointments with their Members of Congress. You can download the conference flyer here.

The conference snapshot looks like this:

Leadership Day – Wednesday, April 26 – CRT focused presentations covering health care reform, federal and state regulatory/legislative issues, and getting prepped for Congress. The schedule: 10:00 AM to 11:30 AM “Health Care Reform”; 11:30 AM to 1:00 PM- Lunch On Your Own; 1:00 PM to 3:00 PM “Industry Update”; 3:00 PM to 3:30 PM- Networking Break; 3:30 PM to 5:00 PM “Congressional Prep and State Delegation Meetings”; and 6:00 PM to 8:00 PM- “CRT United Reception”.

Capitol Hill Day – Thursday, April 27 – Our historic annual lobbying event. Providers, manufacturers, consumers, and clinicians will take the CRT message directly to Congress through in-person meetings on Capitol Hill. The schedule: 9:00 AM to 4:30 PM Capitol Hill Visits; and 6:00 PM to 7:30 PM “Debriefing Reception”.

Now’s the time to get signed up so you get a spot and hotel room. Don’t wait too long and risk being shut out. You can get more details and register at www.ncart.us or www.nrrts.org.

This promises to be a great conference and we look forward to seeing many of you there!

Regards,

Don Clayback, NCART
dclayback@ncart.us

Weesie Walker, NRRTS
wwalker@nrrts.org

CRT Separate Benefit Category Legislation Reintroduced

January 31, 2017

CRT Stakeholders,

Great news from Congress for people with disabilities who rely on Complex Rehab Technology!

CRT Champions Representatives Jim Sensenbrenner (R-WI) and Joe Crowley (D-NY) have joined together to reintroduce the “Ensuring Access to Quality Complex Rehabilitation Technology Act of 2017” in the House of Representatives. The new bill number is H.R. 750.

In his announcement (see here), Representative Sensenbrenner stated “As a leader in the fight for the rights of the disabled, I want to ensure all Americans have access to the tools needed to live each day to the fullest. Disabled Americans should not be denied rehabilitation or medical equipment that can enable them to live and work freely and independently.”

Representative Crowley said in his announcement (see here), “This legislation would guarantee that patients have access to the high-quality products and services they need to lead a more independent life. For those with disabilities and other medical conditions, these complex rehabilitation technology products are necessities.”

The CRT Community is very thankful to Representatives Sensenbrenner and Crowley for their continued leadership in protecting access for people with disabilities. This legislation finished last year with strong bipartisan support with 173 Representatives and 20 Senators signed on.

We will be updating our websites and supporting materials to assist Stakeholders in reconnecting with their Members of Congress to re-sign past cosponsors or secure new cosponsors in this Congressional session.

On another important front, work is underway to reintroduce legislation in Congress to provide a permanent stop to the application of Medicare Competitive Bid pricing to CRT Wheelchair Accessories. This bill is expected to be reintroduced as we move into February.

Thanks for your continued support! Stay tuned for more details.

Regards,

Don
Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

Medicare Eliminates Billing Option for Certain Manual Wheelchair Upgrades

January 26, 2017

CRT Stakeholders,

Last month the DME Medicare Administrative Contractors (MACs) issued a joint publication indicating that titanium wheelchair frames and patient weight capacity upgrades were not separately billable to Medicare.  A copy can be found here.  The article indicates these features were included in the initial fee schedules developed for manual wheelchairs.

This is the most recent example of policy changes and re-interpretations over the past few years implemented by CMS and its contractors that eliminate access.  This policy announcement prevents Medicare beneficiaries with disabilities from obtaining complex rehab technology (CRT), even if they are willing to pay for upgrades themselves.

To work to resolve this access problem, we have formed an NCART Work Group and developed an Issue Paper to share with policy makers and advocates.  A copy can be found here.  We have also reached out to CMS with our concerns and are pursuing other channels in the Congressional and advocacy arenas.

We will keep you updated on our progress and next steps that may be required.

Regards,
Don

Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

P.S. If you know of other CRT stakeholders who would like to receive these types of updates please have them sign up at the NCART website.

Medicare CRT Wheelchair Billing Announcements

December 28, 2016

Dear CRT Providers and Manufacturers,

We wanted to notify you of 3 significant Medicare billing announcements that will impact you in 2017:

1.) Continued Use of KU Modifier for Billing for Group 3 Power Wheelchair Accessories with Dates of Service from January 1, 2017 through June 30, 2017- CMS has announced that “Section 16005 of the 21st Century Cures Act extends the PAMPA provisions of unadjusted fee schedules for Group 3 wheelchair accessories and cushions used with Group 3 complex rehabilitative power wheelchairs through June 30, 2017. To implement the extension, the 2016 KU fee schedule amounts have been updated by the 2017 0.7 percent covered item update and will be added to the 2017 DMEPOS fee schedule file. Suppliers should continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs with dates of service January 1, 2017 through June 30, 2017.” This is very good news and should prevent an interruption in the processing of these claims as we move into 2017.

2.) Payment Cut Recoupment for CRT Manual Wheelchair Accessories with Dates of Service from July 1, 2016 through December 31, 2016- Per the 21st Century Cures Act, the July 1, 2016 fee schedule (with related payment cuts to non-competitive bid areas) was rescinded until the issuance of the January 1, 2017 fee schedule. The result of this is CRT providers will be able to recoup any July 1 payment cuts that were incurred for CRT manual wheelchair accessories (and other impacted DME claims such as Group 2 Power Wheelchairs) with dates of service from July 1, 2016 through December 31, 2016. CMS has announced that it “is currently working to implement this section and will be providing contractor instructions for re-processing the applicable claims. There is no action required for the suppliers at this time. Formal instructions will be issued in the near future.” Here again, good news that will allow providers to reprocess these claims to obtain additional payments once specific instructions are issued by CMS.

3.) Required Prior Authorization for 2 Group 3 CRT Power Wheelchair Base Codes (K0856 and K0861)- CMS has announced that they will be putting in place a Prior Authorization system for 2 CRT power wheelchair codes: K0856- power wheelchair, group 3 std., single power option, sling/solid seat/back, up to 300 pounds; and K0861- power wheelchair, group 3 std., multiple power option, sling/solid seat/back, up to 300 pounds. This is part of a national DME Prior Authorization initiative and these first codes will be implemented in 2 phases. The initial phase will be effective on March 19, 2017 in the 4 states of Illinois, New York, West Virginia, and Missouri. The second phase will be effective in the remaining states in July 2017. The CMS Fact Sheet can be found here and provides additional details, including the goal of an initial prior authorization response within 10 days. We will be working with CMS on the implementation of this new system.

Thanks to everyone who worked hard to get the year-end legislation passed in Congress to provide the payment relief in items 1.) and 2.). We will share additional information as it becomes available.

Regards,

Don
Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

Congress Passes Six-Month Delay in CRT Power Accessories Cuts

December 8, 2016

Good News for CRT Stakeholders.

Yesterday afternoon the Senate passed a 6-month delay of inappropriate Medicare payment cuts to CRT power wheelchair accessories as part of the 21st Century Cures Act. The House of Representatives passed the bill last week and it now goes to the President for signing into law.

The Cures Act also includes Competitive Bidding “rural relief” language that will retroactively rescind the broad DME July 1, 2016 Medicare cuts until January 1, 2017. This will allow CRT providers to recoup payment reductions to CRT manual accessories and other items provided from July 1 to December 31, 2016. The rescinded payment cuts will go back into effect on January 1, 2017.

As we have reported, the year-end challenge was to get our CRT legislation attached to a larger bill before Congress adjourned. Thankfully we were included in a year-end bill. Unfortunately, it is a short-term fix and does not expand the delay to CRT manual wheelchair accessories.

The reality is our Congressional supporters worked hard to get the best relief achievable within a difficult and limited year-end legislative environment. This 6-month period allows time for us to work with next year’s new Congress and Administration to pursue a permanent and more expansive fix through policy or legislation.

We will start 2017 with Congressional CRT support at its highest level ever. This provides a solid foundation to get a permanent stop to these inappropriate CRT accessories payment cuts and to establish a Separate CRT Benefit Category.

We sincerely thank all the Members of Congress for their support, particularly our CRT champions. Our champions include Senators Portman (R-OH), Casey (D-PA), Cochran (R-MS), and Schumer (D-NY) along with Representatives Zeldin (R-NY), Sensenbrenner (R-WI), Crowley (D-NY), Brady (R-TX), Tiberi (R-OH), Kelly (R-PA), Nunes (R-CA), Price (R-GA), Loebsack (D-IA), Larson (D-CT), DeGette (D-CO).

Please email your Members and thank them. Let them know we look forward to working with them next year to get the needed permanent changes implemented to protect access for people with disabilities.

Finally, thanks to all the people and organizations who worked hard this year reaching out to Congress to secure their support. CRT stakeholders are proving that while it takes time to get the attention of Congress, if you have a good plan, good advocates, and polite persistence progress can be made.

More details will follow as we move ahead.

Regards,

Don

Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

House Passes 21st Century Cures Act

December 1, 2016

Good news! Last night the House of Representatives passed the 21st Century Cures Act, which includes our 6-month CRT power wheelchair accessories delay, by a vote of 392-26. This shows overwhelming support in the House and sends a strong message to the Senate.

The Senate will now take up the bill, likely next week. It may encounter some resistance there, but signs are positive for passage. In the meantime, reaching out to your Senators and encouraging them to vote yes will be helpful. The NCART Board of Directors will be in D.C. next week carrying that message.

We are halfway there. Let’s keep the momentum going and we will keep you updated.

Regards,

Don
Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

Extended Delay of CRT Accessories Cut in House Bill

November 28, 2016

CRT Stakeholders and Friends,

Language to extend the current delay in Medicare cuts to CRT power wheelchair accessories to July 1, 2017 has been added to legislation to be considered this week. The House of Representatives has included a 6-month extension in the “21st Century Cures Act”, a 996-page bill relating to medical/healthcare research, innovation, and treatment.

The Cures Act is expected to be voted on this week in the House of Representatives and once passed it will go to the Senate for their vote, likely next week. Should it be passed by both chambers, it would then go to the President for signing.

As we’ve reported, our challenge was to get attached to a larger bill. So it is good news we are in a bill that will be voted on in lame duck. The not-so-good news is it does not expand the delay to CRT manual wheelchair accessories.

The reality is, given the difficult and limited year-end legislative environment, our supporters worked hard to get the best relief achievable. The 6-month period kept the CRT legislation cost down and most importantly allows time for next year’s new Administration/Congress to pursue a permanent fix through policy or legislation.

The Cures Act also includes Competitive Bidding “rural relief” language that would retroactively rescind the broad DME July 1, 2016 Medicare cuts until January 1, 2017. Providers would be able to recoup CB payment reductions incurred for dates of service from July 1 to December 31, 2016. The rescinded payment cuts would go back into effect on January 1, 2017.

Getting a CRT delay included in the Cures Act is only the first step. Now the bill must be passed in the House and Senate, which is not an automatic process. We need to stay engaged as things move ahead.

We will provide further updates as we move through this week.

Regards,

Don
Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

Happy Thanksgiving

CRT Stakeholders and Friends,

As we prepare to celebrate this important holiday, we wanted to take a minute and wish you a sincere Happy Thanksgiving.

We are very thankful for all your support and assistance throughout the year collectively fighting to protect access to CRT.  It’s not easy finding time for advocacy, but your participation is critical and is paying off.

We also are very thankful to those Members of Congress, their staff, and other policy makers who are “getting the CRT message” and doing their part to help.

Of course we can’t pass up an opportunity to remind you to use www.protectmymobility.org to send your Members of Congress a Thanksgiving message to stop the January 1 cuts to CRT wheelchair accessories.

Please accept our warmest Happy Thanksgiving wishes and enjoy the time with your family and friends.

Regards,

Don

Donald E. Clayback

Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754

CRT Wheelchair Accessories Legislation Update

October 6, 2016

CRT Wheelchair Accessories Legislation Update

Can December 31 major Medicare payment cuts to Complex Rehab wheelchair accessories be stopped?  The solution rests in getting Congress to pass needed legislation before year-end.

While Congress is currently in recess for the elections, they return on November 14 for the “lame duck” session.  This year-end session will be a hectic time, but it’s the opportunity for passage of House bill H.R. 3229 and companion Senate bill S. 2196 to stop these cuts.

To help publicize the issue and get more folks to reach out to Congress an ad was placed in an Assistive Technology Insert published last Friday in USA Today in the cities of Chicago, Dallas, Los Angeles, and New York City.  Share the ad with others in your circle of friends, associates, and organizations to get them to let Congress know this legislation MUST get passed this year.

The legislation also received a boost from a September 28 letter to Congress from the National Disability Leadership Alliance. Sincere thanks goes to them for their support.

As we look toward year-end we have a solid base of support from 145 Representatives on H. R. 3229 and 25 Senators on S. 2196.  The co-sponsor list can be found here.  But getting significant support is not the same as getting a bill passed.  We need to leverage our progress and get Congress to pass the legislation before they adjourn in December.

To make that happen Members of Congress must continue to hear from their constituents over the next several weeks as they discuss priorities and plans for the lame duck session.  The message to them is the Complex Rehab wheelchair accessories bill is “must pass” legislation.

With that in mind, please reconnect with your Members using the email here or by calling them through the Congressional switchboard at 202-224-3121.  If they are already a co-sponsor, thank them and emphasize the need to pass this legislation when they come back after elections.  If they are not signed on yet, make that request and stress the need for passage.

There’s a great deal at stake.  People with disabilities continued access to needed Complex Rehab wheelchairs and accessories depends on Congress passing H.R. 3229 and S. 2196 this year.  It’s up to us to help Congress do the right thing.

Thanks for taking the time to reconnect with your Members and being part of the year-end push.  Let us know if we can be of assistance and we’ll keep you posted as we move ahead.

Regards,

Don
Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754
dclayback@ncart.us |www.ncart.us

P.S. If you know of other CRT stakeholders who would like to receive these types of updates please have them sign up at the NCART website.