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GAO-16-640R 1 (2016-06-01)

handle is hein.gao/gaobaajxy0001 and id is 1 raw text is: G A O U.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 June 1, 2016 Congressional Committees Medicare: Utilization and Expenditures for Complex Wheelchair Accessories The Medicare fee-for-service (FFS) program spends millions of dollars annually to furnish wheelchairs and wheelchair accessories to Medicare beneficiaries.1 Based on medical necessity, Medicare provides coverage for a total of 73 types of wheelchairs and 193 accessories such as headrests and seat cushions. The covered wheelchairs range from basic standard manual wheelchairs to individually configured power wheelchairs with multiple power accessories for individuals with permanent or progressive conditions, such as multiple sclerosis. (See enclosure 1 for a graphic of different types of wheelchairs.) Some manual and power wheelchairs can accommodate complex rehabilitative technology (CRT) accessories-and are referred to as CRT wheelchairs. Both we and the Department of Health and Human Services' Office of Inspector General have reported that Medicare and its beneficiaries have sometimes paid higher-than-market rates for power wheelchairs and other durable medical equipment (DME) items.2 To achieve savings on these items, Congress required the Centers for Medicare & Medicaid Services (CMS)-the agency that oversees the Medicare program-to phase in a competitive bidding program (CBP) for certain DME items in which suppliers compete in order to provide certain DME items and services within designated competitive bidding areas.3 Beginning in 2008, CMS began phasing- in the CBP by rounds with each round operating in particular geographic areas for a defined period of time. The CBP started in bidding areas comprised of nine major cities and their surrounding suburbs and is currently operating in 109 bidding areas. Wheelchairs and accessories included in the CBP and provided in CBP areas are subject to competitively set payment rates that must be less than or equal to rates established for the same items by Medicare's fee schedule.4 The Medicare Improvements for Patients and Providers Act of 2008 terminated the first round of the CBP and excluded a subset of CRT power wheelchairs-those 1Medicare is a federally financed health insurance program for individuals age 65 or over, certain individuals with disabilities and individuals with end-stage renal disease. Wheelchairs and accessories are typically obtained from durable medical equipment suppliers, who then submit claims for payment to Medicare. 2In August 2009, the U.S. Department of Health and Human Services' Office of Inspector General reported that Medicare and its beneficiaries paid almost four times the average suppliers' costs to acquire standard power wheelchairs and almost two times the average suppliers' costs to acquire complex rehabilitation power wheelchair packages during the first half of 2007. Office of Inspector General, Department of Health and Human Services, Power Wheelchairs in the Medicare Program: Supplier Acquisition Costs and Services, OEI-04-07-00400 (Washington, D.C.: August 2009). GAO, Medicare: Review of the First Year of CMS's Durable Medical Equipment Competitive Bidding Program's Round I Rebid, GAO-12-693 (Washington, D.C.: May 9, 2012). 3DME suppliers submit bids to provide all of the items within a specific product category. A product category is a grouping of related items used to treat a similar medical condition. 4The fee schedule is a listing of fees used by Medicare to pay for DME. Fees are adjusted for each state, reflecting the geographic price differences that are subject to national floor and ceiling payment limits. In the competitive GAO-16-640R Medicare Page 1

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