Complex rehab as capped rental?

WASHINGTON - CMS proposes saving millions of dollars by reclassifying certain HME as capped-rental items, but stakeholders say this move doesn't make sense for pediatric and tilt-in-space complex wheelchairs. 

CMS issued a proposed rule July 3 that, among other things, clarifies the definition of routinely purchased equipment, effectively making about 80 codes, including certain complex rehab codes, capped-rental items.

“They're basing these savings on the fact that most capped rental items are returned after eight months,” said Rita Hostak, vice president of government relations for Sunrise Medical and a member of the NCART workgroup putting together comments on the rule. “For us (in complex rehab), that won't happen. These are people with permanent, long-term disabilities.”

CMS anticipates the changes would save $130 million over five years.

Stakeholders say making certain complex rehab capped-rental items would be a lose-lose situation. CMS would have to process claims 13 times instead of once, and providers would have to wait 13 months to receive full payment for high-priced equipment.

“We're talking about thousands of dollars for this equipment,” said Rex Maxey, president of Binghamton, N.Y.-based Penn York Medical Supplies. “This is the worst thing they could do.”

While some providers have been able to make the capped-rental system work for standard power wheelchairs (a policy CMS put in place in 2011), complex rehab is a different story, stakeholders say.

“Complex rehab doesn't have the volume that the Group 2 chairs have,” said Doug Crana, president of Newburgh, N.Y.-based Consolidated Medical. “Being the bank for Medicare, as they make providing this equipment more complicated, would be a very negative thing.”

Stakeholders have until Aug. 30 to comment on the rule. As it currently stands, the changes would go into effect Jan. 1, 2014.

“We need to convince CMS this doesn't make sense for them or any stakeholder,” said Hostak.