Medicare:

2016 Payment Rates for Complex Wheelchair Accessories

GAO-16-840R: Published: Aug 31, 2016. Publicly Released: Aug 31, 2016.

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Contact:

Kathleen M. King
(202) 512-7114
kingk@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

People with conditions like multiple sclerosis may rely on complex power wheelchairs to get around. These wheelchairs can require special accessories, like power seating systems to reposition people who can’t move themselves.

In 2016, Medicare was scheduled to begin paying new, lower rates for accessories used with certain complex power chairs, but Congress delayed this change for 1 year. To estimate the effect of these lower rates, we compared them to what Medicare was previously paying for each of the top 50 accessories. The new rates were 3 to 50 percent lower, and could save Medicare and beneficiaries $19 million a year.

Wheelchairs and Accessories Awaiting Distribution

Photograph of wheelchairs and accessories awaiting distribution

Photograph of wheelchairs and accessories awaiting distribution

Additional Materials:

Contact:

Kathleen M. King
(202) 512-7114
kingk@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

What GAO Found

GAO reviewed 2016 Medicare payment rates for complex wheelchair accessories—both the fully adjusted rates based on the durable medical equipment competitive bidding program (CBP) and the unadjusted rates for the same items. The Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—classifies power wheelchairs into five groups ranging from wheelchairs with no special features to those, such as group 3 wheelchairs, that can accommodate complex rehabilitative technology (CRT) accessories. GAO found that the 2016 fully CBP-adjusted payment rates ranged from 3 to 50 percent lower than the unadjusted fee schedule payment rates for the 50 accessories with the highest estimated expenditures when furnished in connection with CRT power group 3 wheelchairs. Once these rates go into effect for complex wheelchair accessories, GAO estimates that the Medicare program and beneficiaries would save approximately $19 million per year.

Why GAO Did This Study

The Medicare fee-for-service program spent $311 million during 2014 to furnish wheelchair accessories to Medicare beneficiaries, of which about half was for accessories furnished in connection with CRT power group 3 wheelchairs. Beginning January 1, 2016, CMS was required to begin adjusting its Medicare fee schedule rates based on competitively set rates for items and geographic areas included in the durable medical equipment CBP. Congress required CMS to phase in the CBP program over time to achieve savings on durable medical equipment items. In the CBP, suppliers compete in order to provide certain durable medical equipment items within designated bidding areas. CMS began adjusting fee schedule rates for CBP items on January 1, 2016, starting with a 50-50 blend of CBP-adjusted and unadjusted rates for the first 6 months. However, the transition to adjusted payment rates for wheelchair accessories when furnished in connection with CRT power group 3 wheelchairs was delayed for 1 year by the Patient Access and Medicare Protection Act. The law also included a provision that GAO report on utilization, expenditures, and payment rates for complex wheelchair accessories. GAO issued a report on June 1, 2016, that included a comparison of the 50-50 blended adjusted payment rates that were available at the time of its review to the unadjusted payment rates. CMS subsequently published the fully CBP-adjusted rates, and GAO was asked to update its analysis of payment rates for complex wheelchair accessories. This report provides information about how the fully CBP-adjusted fee schedule rates for complex wheelchair accessories compare to the unadjusted rates for the same items, and estimates the annual savings to the Medicare program and beneficiaries once these fully-adjusted rates go into effect.

To conduct this work, GAO used July 1, 2016, fee schedule data. For each of the 50 accessories with the highest estimated expenditures when furnished in connection with CRT power group 3 wheelchairs, GAO calculated the average unadjusted payment rate across urban areas and compared that to the average fully CBP-adjusted rate by determining the percentage difference.  GAO also used this percentage difference and each accessory’s 2014 estimated expenditures when furnished in connection with CRT power group 3 wheelchairs to estimate the annual savings to the Medicare program and beneficiaries once these rates go into effect.

We provided a draft of this report to the Department of Health and Human Services for comment. The department provided technical comments that were incorporated, as appropriate.

For more information, contact Kathleen M. King at (202) 512-7114 or kingk@gao.gov.

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