Author Archives: Mickae Lee

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.

Wheelchair Accessories Legislation Gains Support

August 31, 2016

Wheelchair Accessories Legislation Gains Support

CRT Stakeholders and Friends,

Yesterday Representative Lee Zeldin (R-NY), the House sponsor of our complex wheelchair accessories bill H.R.3229, held a press conference at The Children’s Center at United Cerebral Palsy (UCP) of Long Island, a school for students with developmental disabilities. The purpose of the press conference was to call for Congress to pass H.R.3229 this year, legislation that he labeled as a “must pass” bill to protect access for people with disabilities.

Other CRT stakeholders in attendance also spoke in support. These included Stephen Friedman, President and CEO of UCP of Long Island; Rolf Walter, a 50 year client of UCP who uses a CRT power wheelchair; and Linda Bollinger-Lunger, a physical therapist with Long Island Select Healthcare who has been delivery CRT seating and mobility for 17 years. All three did a very good job in emphasizing the critical need to protect access to CRT and for Congress to pass this bill.

The press conference was well attended and Representative Zeldin was joined by local elected officials, staff of UCP of Long Island, residents from UCP of Long Island’s 31 homes, advocates for individuals with disabilities, and members of the community. You can view the 20 minute press conference here and the related press release can be found here.

In addition to the press conference, national consumer, patient, and clinician organizations have once again communicated in writing to Congress urging passage of H.R.3229/S.2196.

The Consortium for Citizens with Disabilities (CCD) sent a supporting letter signed by 26 national organizations to Congress on August 18th. The ITEM Coalition followed up with a similar letter signed by 37 national organizations on August 25th. Those letters can be found and downloaded here.

We sincerely thank Representative Zeldin and the members of the CCD and the ITEM Coalition for their continued leadership and support.

These positive developments come at an excellent time and let Congress know this legislation must be passed this year. The documents and information can be shared as part of your follow up with the offices of your Representative and Senators. We need all 3 of your Members signed on as co-sponsors to build on this momentum!

Congress will be back in session starting next Tuesday for most of September and next week is the ideal time for follow up. Use the resources at www.access2crt.org to see if your Members have signed on and to make additional outreach as needed.

Regards,

Don

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

DME Rural Relief Legislation Did Not Pass

July 18, 2016

NCART Board and Supporters,

Unfortunately the Congressional legislation to impose a 3 month delay to the implementation of the July 1 DME cuts failed to pass the Senate on Friday.

Accordingly, the July 1 cuts will remain in effect unless Congress takes action when they return in September after their summer recess.

The 3 month delay legislation had passed in the House. But it failed to pass in the Senate on Friday due to a “hold” placed by an unidentified Senator as part of the Senate’s “hot line” process.

This further emphasizes the need to secure passage of H.R. 3229 and S. 2196 to stop the application of competitive bid rates to CRT power and manual wheelchair accessories.

We had a very good showing and discussions in Congress last week to secure passage of the CRT accessories legislation.

We will be sharing more details on that and on needed next steps shortly.

Don

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

CMS Releases July 1 Medicare DME Fee Schedules with Major Cuts

June 24, 2016

CRT Stakeholders and Friends,

Late yesterday afternoon CMS finally released the July 1 Medicare DME Fee Schedules. A mere 5 business days before the reduced payment amounts go into effect!

As feared, the payment reductions due to the full application of Competitive Bid Program information, including new data from the recent Round 2 Recompete, are major.

Unfortunately HME legislation to delay these cuts was passed in the Senate on Tuesday, but a similar bill in the House that was scheduled for a vote Wednesday was never acted on due to the Congressional “sit-in” and the subsequent adjournment of the House until July 5.

The related CMS Fact Sheet can be found here. Based on that document, the July 1 payment amount cuts (from 2015 payment amounts) for DME items include: Oxygen Concentrator 56% cut; Nebulizer 68% cut; Hospital Bed 55% cut; Walker 58% cut; Commode 56% cut; Standard Manual Wheelchair 60% cut; and Standard Power Wheelchair 53% cut.

The detailed July 1 Fee Schedules can be found here.

We are in the process of analyzing the July 1 payment cuts that apply to wheelchair accessories and will report that information as soon as our analysis is complete.

These major reductions further underscore the need for us to push for passage of H.R. 3229 and S. 2196 this year to protect accessories used on complex rehab power and manual wheelchairs!

More to also follow on that.