ATLANTA — In the first glimmer of hope for mobility
providers in a long while, a bill to delay elimination of the
first-month purchase option for power wheelchairs could come
through as early as this week.
Mandated by the Affordable Care Act, the first-month purchase
option for Group 2 PWCs is scheduled to be eliminated as of Jan. 1,
2011. Rather than getting reimbursed up front, providers would have
to wait 13 months before receiving Medicare's full payment for the
power chairs. (The mandate does not apply to providers serving the
Round 1 competitive bidding areas.)
Stakeholders have been working to stave off the elimination but
were not able to move forward with a bill until the Congressional
Budget Office issued a score for the delay. That score — $50
million for a 12-month delay — has been released.
"Now that we have the CBO score, the purchase option delay is
being put into legislative language and we are looking to have that
introduced maybe as early as [this week]," said Pride Mobility
Products' Seth Johnson, vice president, government affairs, adding
that the legislation will be introduced in the Senate.
Johnson said both the Senate Finance and the House Ways and
Means committees have expressed support for a 12-month
implementation delay.
"They recognize that when they drafted the [health reform] bill,
there was significant time for the industry and CMS to adjust to
this change," Johnson said, pointing out that providers will have
to change their business model and CMS will need to put together
significant guidance on the change. "But the reality is that by the
time the bill was signed, there was [less than a year]."
Oddly, the lagging economy has aided in hanging onto the
purchase option a while longer.
"Many providers are unable to secure the financing to cover the
upfront cost of the power wheelchairs," Johnson explained. "Banks
are unwilling to loan money, credit is so tight. And you cannot use
a Medicare receivable as collateral. So we really need additional
time to allow for the economy to continue to recover. Hopefully,
assuming we get the delay, banks next year will be lending money
again, and the transition to this model will be easier."
Johnson also said consumer groups are very concerned about the
access issue. The National Council on Independent Living, the
United Spinal Association and the National Spinal Cord Injury
Association have already weighed in on the issue with letters to
key congressional committees. They recognize, he said, that
"providers don't have the financial wherewithal to adjust to his
change."
Consequently, Medicare beneficiaries trying to get new chairs or
even fix older ones could run into significant trouble, "and there
won't be anyone in many areas, especially in rural and underserved
areas, to assist these customers with their existing power
wheelchairs," Johnson said.
He is optimistic the delay bill will go through. "We had eight
or so meetings [with legislators on Capitol Hill last week], and I
haven't heard any opposition at all to delaying the transition into
the mandatory rental model."
But he delay won't come for free, he pointed out. Providers will
have to "pay" $50 million for it, most likely through taking a 1
percent cut in their portion of the CPI update. Still, said
Johnson, it is the best the mobility sector can hope for. "There's
no talk of a repeal right now," he said. "Those in power in
Congress are not interested in repealing any portion of the care
act."
The mobility sector is also grappling with competitive bidding, which will
cut an average 32 percent chunk out of Medicare allowables for bid
products. Those cuts run higher for power wheelchairs in several
areas, as much as 37.5 percent for a K0823 chair in Orlando,
Johnson said.
"Many of the rates appear unsustainable, especially when you
consider the reductions that have already occurred to the product
category in recent years," he said.
HME advocates have been pushing for passage of H.R. 3790 to
eliminate the bidding program. But with CMS estimating a $17
billion savings from the program over 10 years, the bill's pay-for
doubled over what stakeholders had anticipated.
American Association for Homecare board members met last week in
Chicago to discuss the issue and go over the data available so far
about the bidding program. CMS has divulged little information
about Round 1 except the rates; names of contract holders won't be
revealed until September.
Johnson said Pride, along with other companies and associations,
is trying to identify problems areas within the bidding program.
"The more we call into question the decisions that were made in
awarding bids, the stronger the chance to delay the program or stop
it," he said. "But until we see the providers that CMS ultimately
contracts with, we won't have any of the information we really
need."
During the first Round 1 in 2008, Pride identified bidding
improprieties in the Riverside, Calif., CBA and, along with several
members of Congress, called for an investigation. Concerns centered
on reports that a health care consultant worked directly with a
wholesale distributor to establish pricing levels for PWCs in that
CBA. In the end, of the 19 providers the consultant worked with, 18
won contracts with nearly identical bids.
Johnson said Friday that neither Pride nor any of the
legislators heard from CMS regarding the call for an investigation.
However, he said, "when you look at the number of winners for this
round, I do believe that since 46 of 48 bidders won, CMS did take
into account the information that was alleged to have occurred last
time when they evaluated the bids this time."
That doesn't necessarily mean that all is well in the Riverside
CBA, however.
"My only concern, and one of the things we are looking into in
Riverside, is why are there so many [power wheelchair] winners?
Forty-six seems like a lot of winners in that category," said
Johnson. "You wouldn't need that many to fill the capacity
bucket."
For a chart showing the number of contracts offered for all
product categories in the nine Round 1 CBAs, see the
target="_blank">CBIC website.
