WASHINGTON, DC – New legislation to establish a separate benefit for Complex Rehab Technology (CRT) wheelchairs under Medicare has been introduced in the House. H.R. 2408, sponsored by Reps. Jim Sensenbrenner (R-Wisc.) and Brian Higgins (D-N.Y.), will allow CMS to develop new coverage policies and standards that reflect the significant differences between CRT and other HME, including the training and high level of service associated with these products and the profound physical challenges for patients who require CRT. See additional perspective on the need for Separate Benefit legislation in this policy brief that also notes some of the leading organizations supporting the bill.
The new legislation joins two other CRT bills introduced over the last 18 days. S. 1223 and H.R. 2293 would exclude manual CRT wheelchairs from the bidding program and suspend the use of bidding-derived pricing for manual CRT accessories. These bills would affirm long-held Congressional intent to keep CRT products out of the bidding program and sensibly align reimbursement policy for manual CRT accessories with CMS’ 2017 decision to exempt group 3 power CRT accessories from bidding-derived pricing.
“We’re encouraged that Congressional advocates for CRT remain committed to policies that will help ensure patient access to these highly specialized products and related services,” said Tom Ryan, AAHomecare president & CEO. “We appreciate the significant work that NCART and other mobility stakeholders, along with patient group leaders, have put into building support for CRT legislation on Capitol Hill. We look forward to helping make the case for these new bills and other HME policy priorities at our upcoming Legislative Conference and in the months ahead.”
CMS Confirms Implementation Dates for Prior Authorization Expansion
CMS has confirmed the implementation dates for the addition of seven PMD CRT items and five support surfaces items to the national Prior Authorization (PA) program. PMD CRT codes will go into effect on July 21, but support surfaces will be implemented in two phases. California, Indiana, New Jersey, and North Carolina will require PA for the five support surfaces codes beginning July 21 and then it will be implemented nationally on October 21.
Although AAHomecare is supportive of certain DME items being included in the prior authorization program, we do not believe all items are suited under the current PA guidelines. CMS has a 10-business day timeline to make an initial PA decision and 2 business days for expedited review process for certain situations. AAHomecare is concerned about the potential impact on timely access to care for beneficiaries in need of support surfaces. CMS will be providing further guidance, on these items in a subregulatory guidance but in the meantime AAHomecare has reached out to CMS over these concerns.
There are several benefits for suppliers to have items in the PA program, such as getting an item prior authorized guarantees payment by Medicare for the items and services without any time delays or additional paperwork. It also provides suppliers some protections from future audits. There is currently a total of 45 codes that are included in the PA program and 135 items on the master list that are eligible to be included in the PA program. More information on the PA program can be found on CMS’ website.
Supplier Numbers Edge Lower
WASHINGTON, DC – AAHomecare’s updated quarterly supplier number analysis shows a decrease in the number of suppliers. As of January 2019, there are approximately 6,143 unique traditional DMEPOS suppliers and 9,195 traditional DMEPOS locations, which is a 37% decrease in unique suppliers and 35% decrease in locations since the inception of the competitive bidding program. Since our last quarter reporting (October 2018), we see about a 3% decrease for both companies and locations. You can find AAHomecare’s updated supplier tracking sheet here.