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Permobil Government Affairs: Quarterly Newsletter – June 2017

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Permobil Government Affairs: Quarterly Newsletter – June 2017

CRT SUCCESS!

As many of you are aware, on the afternoon of June 23, the Administration put out a no-tice that reversed the impending cuts to CRT accessories for Group 3 and higher power wheelchairs. This decision is a permanent fix and will not require additional delay legisla-tion like we have worked on before. After 2 years of fighting, it is great to have a win! A big thank you from the Government Affairs Team for everyone who reached out to their Congressmen and Senators during this strug-gle to make sure our voices were heard. All the hard work paid off and we are most grate-ful to our champions for helping us with this fight.

Here is a link to the notice with the changes:
https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html

MANUAL WHEELCHAIRS

While we have had good news on the power wheelchair front, we are facing some significant challenges with manual chairs. Now that we have the CRT power accessories cuts re-solved, the Government Affairs Team will focusing on how we can combat and address the challenges facing our manual chair users.

TITANIUM UPGRADES

This has been an ongoing challenge for the industry since Medicare put out the notice back in December 2016 disallowing the ability for a titanium upgrade to be separately billable for a K0005 chair. By claiming that the code and corresponding fee schedule included the price of titanium materials when it was created, they have restricted access and the ability for an individual to get a titanium chair even with their own money.

As has been stated in past communications, Permobil believes their claims are wrong and we are taking steps to push Medicare to reconsider their actions. We are still awaiting a response from our second Freedom of Information Act (FOIA) request to come back asking for the data to prove titanium materials were included and have had direct contact with the DMEPOS policy staff. Industry and advocates have all sent letters to the Administration challenging the notice and many long time users of titanium chairs are beginning to realize that it is no longer and option for them as they go to order new chairs.

In an effort to coordinate the various stakeholders, Permobil created a landing page with information about the notice, a way to contact Congress, and a script that can be used for emails or phone calls. Additionally, a recent article I wrote and distributed is contained on the website along with a paper written by NCART on the subject. Expect to see much more coming on this topic as we put pressure on Medicare.

Below is a link to the website and please pass along to your contacts or interested parties.
http://hub.permobil.com/advocacy

MANUAL CRT ACCESSORIES

Unfortunately, just like in the delays we received for the past couple years from Congress, accessories associated with CRT manual chairs were excluded from this latest fix for or various policy reasons.The team will now make it a priority to focus on this double standard and pressure Congress and Medicare to protect manual users as well. More to come on this front
but keep your eyes open for materials and outreach opportunities.

OBAMACARE REPEAL

The Senate Republican leadership recently released their own health care reform meas-ure dubbed the “Better Care Reconciliation Act” after weeks of work behind closed doors. It has been received with much criticism from both sides of the aisle. The main sticking point for Republicans are the Medicaid provisions which would limit payments to states and phase out expansion, among others changes. Leader McConnell originally scheduled a vote for this week but due to many Senators still expressing concerns about the bill and falling short of the votes necessary to pass, the vote has been postponed until after the July 4th recess. We will continue to monitor the progress of the bill and will provide updates as necessary.

PRIOR AUTHORIZATIONS

I wanted to send a quick reminder that prior authorizations for K0856 and K0861 chairs goes nationwide July 17. While there have been no major issues in the four pilot states, we will keep a close eye on things as the program is expanded. For more information on processing claims, etc., please refer your dealers to the upcoming conference call being facilitated by Medicare on July 6.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/DMEPOS/Prior-Authorization-Process-for-Certain-Durable-Medical-Equipment-Prosthetic-Orthotics-Supplies-Items.html

Please reach out with any questions on these issues or need help in any other area. john.goetz@permobil.com or 615-448-8313

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