The Medicare Modernization Act of 2003 established a competitive bidding program for durable medical equipment (DME) that included complex power wheelchairs and accessories in the bidding list. In 2008 Congress saw this was a problem and passed MIPPA to exempt these products from inclusion in competitive bidding recognizing these products were not appropriate for bidding because of their complexity and individualized nature. MIPPA also included legislation that delayed the implementation of the DME competitive bidding program for 18 months. To pay for the delay, the DME categories selected for competitive bidding were subjected to a 9.5 percent reduction in Medicare reimbursement. Unfortunately, this reduction was also applied to the “exempted” complex rehab products and these products cannot withstand such a reduction. This reduction to complex rehab must be restored.
Basis for Restoration
The reasons that this reduction must be restored as soon as possible include:
•As part of the MIPPA legislation, Congress exempted complex rehab power wheelchairs from competitive bidding because it recognized complex rehab products are different from traditional DME in that they are individually customized to meet the medical and functional needs of people with disabilities. Since Congress exempted these products from competitive bidding, these items should also have been exempted from the 9.5 percent reduction that was applied to traditional DME products as part of MIPPA.
•Complex power wheelchairs are a very small Medicare product category and account for less than 10% of the overall Medicare mobility benefit expenditures. For this limited product group, the most generous savings estimates show less than $10 million annually. While not a minor dollar amount, it is insignificant when viewed in light of the negative consequences the cut has for those individuals with complex disabilities.
•Beneficiaries who have in the past received appropriately configured wheelchairs will be unable to receive comparable products when their mobility systems need to be replaced. This will affect their levels of independence, their mobility, and their ability to function optimally in their environment. Likewise, beneficiaries needing new power wheelchairs may be unable to receive the most appropriate technology. This will lead to more medical complications for complex rehab consumers which will ultimately increase health care costs elsewhere in the Medicare program.
•Access to necessary services and repairs will be reduced. There will be limited availability of offsite assessments and evaluations in addition to delays in accessing chairs and receiving necessary repairs. Reductions in repair services will result.
•Congress did not realize that for complex rehab payments this 9.5 percent reduction would not be limited to just Medicare beneficiaries. It has also been adopted by state Medicaid programs and other third party payers to further reduce available funding of these products. This has further compromised the quality of products and services available across the country.
•Studies indicate that complex rehab technology companies that provide these products and services have pre‐tax profits of less than 4 percent, making them unable to sustain a 9.5 percent reduction without significantly reducing services and limiting the types of products they are able to provide.
Position Paper from NCART 2009