Stakeholders set complex rehab agenda

YARMOUTH, Maine – Stakeholders have shared a list of complex rehab priorities for 2023, including several holdovers from 2022, like securing Medicare coverage for power seat elevation devices. 

On that priority, stakeholders are well on their way, with CMS expected to issue a decision memo on Feb. 15 and, following another comment period, to finalize coverage in May. 

“There are next steps,” said Wayne Grau, executive director of NCART. “If (the decision) is positive, we’ll move to CMS coding and pricing. That takes some management. We need to make sure they have everything coded properly and then priced properly. In the past, they have compared complex rehab to DME, and they’re very different. We have to manage that.” 

If anything unexpected happens leading up to May, stakeholders have to be ready to “go on a legislative round,” Grau says. 

Stakeholders are also prioritizing getting CMS to move forward with Medicare coverage for power standing systems, including opening a comment period. They expect the agency to make a move some time in 2023 and, in the meantime, they’re continuing to collect data to help support their case, Grau says. 

“We’re reaching out to folks to make sure we have the data necessary, so when the comment period opens, we can submit that,” he said. “Those were some of the strongest arguments we had for power seat elevation.” 

Additionally, stakeholders are prioritizing improper denials, service and repair issues, and reimbursement relief. Complex rehab providers will receive an 8.7% increase starting Jan. 1 for equipment and 9.1% for repairs and replacements as part of a CPI-U update, but that doesn’t cover their increased costs – not even close, says Seth Johnson, senior vice president of government affairs for Pride Mobility Products. 

“The cost increases due to the pandemic and ongoing supply chain and inflation and fuel costs continue to present real challenges,” he said. “There is support within Congress for that; there is a real desire to provide relief. We continue to work on that and do everything we can to make the strongest cast possible.” 

• Read the industry’s reaction to CMS’s decision to open a comment period for Medicare coverage for power seat elevation devices but not standing systems.