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NCART LEGISLATIVE AND REGULATORY UPDATE Written by: WAYNE GRAU, EXECUTIVE DIRECTOR OF NCART
POWER SEAT ELEVATION- UPDATE The industry and especially the individuals we serve were delighted the Centers for Medicare and Medicaid Services (CMS) recognized that seat elevation is medically necessary. The coverage effective date was May 16, 2023, and Medicare and the Medicare Advantage plans will cover seat elevation. NCART worked with manufacturers and our providers to gather and submit the information necessary for CMS to make an informed coding and pricing decision. Both the coding application along with the pricing support request have been submitted. We cannot emphasize enough that coverage without proper coding or pricing will hurt consumers. As the writing of this article, the industry awaits the preliminary decision from CMS. Once we have this preliminary decision, the ITEM Coalition and NCART will have the opportunity to testify at a public meeting that has been scheduled for Nov. 28-30. We will keep the industry informed as we receive new information.
UPDATE ON COVERAGE FOR POWER STANDING SYSTEMS The ITEM Coalition held a meeting with CMS officials in September, NCART was in attendance along with consumers, Cara Masselink from CTF, Permobil, and Dr. Shah, a physiatrist from Baylor Medical Center in Dallas, Texas. The CMS staff was attentive and listened as Masselink and Shah presented additional information. The staff from CMS asked if we could forward that information to them for review. CMS did not confirm a date for opening the NCD at this time. However, we have confirmed the NCD for power standing is on the CMS waitlist posted on the CMS website. We will continue to monitor the website for any changes.
UPDATE ON THE CONSUMER CHOICE BILL FOR TITANIUM AND COMPOSITE WHEELCHAIRS- HR 5371 Rep. John Joyce, R, P.A., introduced HR 5371, a consumer choice bill that will rectify a past misinterpretation of Medicare policy. HR 5371 will offer consumers a choice to decide on the proper manual
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wheelchair to fit their lifestyle. Should this legislation become law, consumers will once again be able to choose either a titanium or composite manual wheelchair frame and will be allowed to pay for this upgrade using their own funds. Presently, Medicare beneficiaries are prohibited from upgrading to the equipment that will best fit their specific needs. With the House being focused the last three weeks on electing a new speaker, not surprisingly there were just a couple of co-sponsors: Reps. Glenn "GT" Thompson, R-P.A., and Dean Phillips, D-M.N. We encourage everyone to contact your House member and ask them to co-sponsor the bill. You can find your representative and take action at www.protectmymobility.com.
PARTNERING WITH CTF TO FIGHT IMPROPER MEDICARE ADVANTAGE POWER WHEELCHAIR DENIALS The Clinician Task Force has launched a website to start accepting data about improper Medicare Advantage denials. The data will be used to evaluate whether the Medicare Advantage plans are following Medicare guidelines when they are prior authorizing power wheelchairs. Any information shared with the CTF will be kept confidential. If your company or a consumer you work with has had a power wheelchair you believe has been improperly denied, please go to https://tinyurl.com/3k5mrvmy and submit your information.
THANK YOU I would like to take this opportunity to thank all the consumers who are working with the industry to educate legislators, insurance companies, regulators and others. The first level of communication is understanding and that means educating the other party. The consumers whom we have had the pleasure of working with have helped us more effectively
