From: Home Care Magazine

Coalition gets critical items excluded from Competitive Bidding Program

by Dave McCausland

The implementation of competitive bidding for durable medical equipment by Medicare produced countless challenges for the complex rehab industry to face in ensuring beneficiaries’ access to quality medical equipment and services. 

The first of these challenges was Medicare’s decision in 2007 to competitively bid complex power wheelchairs. The industry met this challenge and overcame it when Congress passed legislation in July of 2008 specifically excluding complex power wheelchairs from competitive bidding.

While this was a major success, it was only the first of many battles. Most recently the battle has shifted to manual wheelchairs and accessories used for complex rehab situations. In the fall of 2011, Medicare announced that it would be launching competitive bidding in 91 of the largest U.S. metropolitan areas, including New York, Chicago and Los Angeles. Further, Medicare announced its intention to competitively bid all manual wheelchairs and items that they deemed to be accessories for those wheelchairs. This created several new challenges associated with specific types of chairs, more complex accessories and items that were assigned to underdefined Medicare codes.

One such group of products was adjustable skin protection seat cushions. These products require significantly more assessment and set-up service. In addition, adjustable skin protection cushions were assigned to underdefined codes that included a myriad of products of varying sizes, shapes, materials, durability, functionality and performance. We were concerned that the bidding of these products under their existing coding structure would create a rush to the bottom and would produce a situation where beneficiaries’ access to the specific goods they needed would be reduced, if not eliminated.

Amid a major crisis within the funding system for wheelchair cushions, we saw an opportunity to make substantial changes to the way adjustable skin protection cushions were classified, so that the codes could represent more clinically homogenous groups of products. We argued that the codes for these products needed to be fixed before competitive bidding began, or excluded.

I am very pleased to say that our combined efforts produced results. On Dec. 27, 2011, the Centers for Medicare & Medicaid (CMS) announced the exclusion of the four adjustable skin protection cushion codes—E2622, E2623, E2624 and E2625—from the upcoming round of competitive bidding.

This was no easy feat; however, we continued to insist that it was impossible to ensure that the end user beneficiaries would have access to the goods they needed under the current coding structure unless substantial enhancements were made.

There are a myriad of individuals and groups that contributed to this successful outcome. Support came from others in the industry, clinicians and end users who wrote letters, sent e-mails, placed phone calls and joined us on our trips to meet with Medicare and members of Congress. Most notable would be the substantial support provided by the Independence through Enhancement of Medicare and Medicaid Coalition (ITEM Coalition), which represents more than 40 of the nation’s leading beneficiary advocacy groups. Additionally, we received strong support from members of Congress, lead by Reps. Jerry Costello (D-Ill.), John Shimkus (R-Ill.) and James Langevin (D-R.I.) and Sen. Richard Durbin (D-Ill.). It was the efforts of the stakeholders and sympathetic members of Congress that made the difference.

The decision by Medicare to pull the adjustable skin protection cushions out of Round 2 of competitive bidding is gratifying. While this is a very clear victory for beneficiary access, it is only the first step in a longer process for adjustable seating. By being pulled out of Round 2, we have been given more time to ensure that the coding and reimbursement structure for these products is enhanced to ensure products are classified and assigned to clinically homogenous groups.

Be assured that the ROHO Group is committed to this effort and intends to give freely of our time, talent and treasure to achieve this goal.