Power Mobility Device Fee Schedule Cuts Prices Drastically
On Oct. 2 the Centers for Medicare and Medicaid Services(CMS) released the fee schedule amounts for the new Power Mobility Device HCPCS Codes scheduled to take effect Nov. 15. The state-by-state fee schedule is posted on the CMS Web site at www.cms.hhs.gov/DMEPOSFeeSched/LSDMEPOSFEE/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=ascending&itemID=CMS1187467. The SADMERC also posted the revised Product Classification List for the PMD codes.
Industry experts and providers alike are in a state of shock especially when CMS' memo to Capitol Hill stated that "the fee schedule amounts for these new codes were established after careful consideration of input from PMD manufacturers and suppliers." In a statement released by Cara Bachenheimer, Invacare's vice president of government relations, "CMS must retract the Oct. 2 PMD prices and work with consumers, physicians, providers and manufacturers to establish fair prices that ensure consumer access to the medically appropriate power mobility device."
The new fees are replete with problems, says
Bachenheimer who provided the following example: "A Group 2 single power option power wheelchair will get paid at a higher rate than a more complex Group 3 single power option wheelchair. At the same time, the price point for that same Group 2 device is less than CMS' identified Internet price.
In a statement released by Invacare, for high end products that are used by consumers with severe disabilities, there will be up to a 41 percent reduction; this will prevent consumers with disabilities from having access to the appropriate power wheelchair unless they are affluent enough to pay for the wheelchair themselves. These products are used by beneficiaries with severe diagnoses such as ALS, muscular dystrophy, cerebral palsy, spinal cord injury and severe brain injury. For consumer/geriatric mobility, the proposed fee schedule calls for a 21-44 percent reduction, which will also prevent need seniors from accessing the appropriate device.
Mal Mixon, chairman and CEO of Invacare Corp. said, "I was in the Rose Garden when former President George H.W. Bush signed the Americans with Disabilities Act into law. I don't believe it is the current Administration's or Congress's intention to effectively prevent people with disabilities from being able to obtain the power wheelchair they need to get around in their homes and communities.
Seth Johnson, chair of the American Association for Homecare Rehab and Assistive Technology Council (RATC), said, "RATC believes that many of these new fee schedule amounts are totally unreasonable and must be corrected. The drastic cuts put in effect by the new fee schedule will reduce access to care and prevent patients from getting the mobility devices they require."
According to AAHomecare, providers of rehab should notify their members of Congress to:
- Ask Congressional leaders to instruct CMS to retract the fee schedule for power mobility devices because the drastic cuts will reduce patient access to medically appropriate equipment.
- Ask Congressional leaders to instruct CMS to develop fair pricing by using an appropriate methodology and working with the rehab community.
The RATC Council and other stakeholders will also ask Congress and CMS to stop any implementation of the fee schedule until CMS can establish fair prices. Johnson said, "We have six weeks before the Nov. 15 implementation deadline to impress upon CMS and Congress the need to make significant changes to the published fee schedule amounts."
AAHomecare will develop talking points and sample letters for providers to use. Access the CMS ceiling and floor fee schedule amounts for the PMD codes (K0800 through K0899) at www.cms.hhs.gov/DMEPOSFeeSched/Downloads/pmd_fee.pdf.
This article originally appeared in the October 2006 issue of HME Business.