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GAO-16-840R 1 (2016-08-31)

handle is hein.gao/gaobaakeg0001 and id is 1 raw text is: GAO U.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 August 31, 2016 Congressional Committees Medicare: 2016 Payment Rates for Complex Wheelchair Accessories 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 complex rehabilitative technology (CRT) power group 3 wheelchairs.1 Beginning January 1, 2016, the Centers for Medicare & Medicaid Services (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 competitive bidding program (CBP).2 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 Patient Access and Medicare Protection Act (PAMPA) enacted on December 28, 2015, delayed for 1 year the application of CBP-adjusted payment rates for wheelchair accessories when furnished in connection with CRT power group 3 wheelchairs. The law also included a provision that we report on utilization, expenditures, and payment rates for complex wheelchair accessories.3 We 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 our review to the unadjusted payment rates.4 Subsequent to the publication of our report, CMS published the fully CBP- adjusted rates for 2016. You asked us to update our analysis of payment rates for complex wheelchair accessories based on the fully CBP-adjusted rates. In this report, we provide information about how the 2016 fully CBP-adjusted fee schedule rates for complex wheelchair accessories-rates that would have applied when furnished in connection with CRT power group 3 wheelchairs if PAMPA had not delayed the transition to adjusted rates-compare to the unadjusted rates for the same items. We also estimate the annual savings to the Medicare program and beneficiaries once these fully-adjusted rates for complex wheelchair accessories go into effect. To conduct this work, we 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, we calculated the average unadjusted payment rate across urban areas and 1The Centers for Medicare & Medicaid Services-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 accessories. 2Congress 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. 3pub. L. No. 114-115, § 2(b), 129 Stat. 3131 (2015). 4Medicare: Utilization and Expenditures for Complex Wheelchair Accessories, GAO-I 6-640R (Washington, D.C.: June 1,2016). GAO-16-840R Medicare Page 1

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