Final rule proves 'CMS does not understand complex rehab,' stakeholders say

WASHINGTON - Industry stakeholders are shaking their heads in disbelief at a final rule that makes certain complex rehab equipment capped-rental items effective April 1.

In the Nov. 22 final rule, CMS designates 78 codes as capped-rental—including codes for tilt-in-space manual wheelchair, pediatric manual wheelchair, and manual wheelchair power-assist. Medicare estimates that this equipment will only be needed, on average, for eight months—saving Medicare $130 million over five years.

“We're extremely disappointed,” said Don Clayback, executive director of NCART. “Stakeholder input to create rational regulations that protect the program and protect beneficiaries was completely ignored.”

After publishing a similar proposed rule in July, CMS received 170 letters explaining that complex rehab equipment is for people with long-term disabilities.

Stakeholders worry that spreading payments for expensive complex rehab equipment over 13 months will be a hardship for providers—especially if state Medicaid programs and other insurers follow Medicare's lead.

“Medicare is not the primary payer for many of these products, but as Medicare goes, so go the rest of the payers, to a large degree,” said Seth Johnson, vice president of government affairs for Pride Mobility. “If providers are unwilling or unable to transition to that model, access is going to be a problem.”

Stakeholders haven't given up the fight. Bills in the House of Representatives and the Senate that would create a separate benefit category for complex rehab could fix the issue if passed—and prevent others like it in the future, they say.

“My hope is that people will get more fired up about the separate benefit,” said Weesie Walker, interim executive director of NRRTS. “This puts the problem in your face: CMS does not understand what complex rehab is.”