TODAY S AGENDA 2/28/2017 CRT FOCUS: WHAT CRT SUPPLIERS CAN EXPECT FROM CAPITOL HILL IN 2017 GAMES 2017 WINTER MEETING FEBRUARY 17, 2017

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1 CRT FOCUS: WHAT CRT SUPPLIERS CAN EXPECT FROM CAPITOL HILL IN 2017 GAMES 2017 WINTER MEETING FEBRUARY 17, 2017 Cara Bachenheimer Invacare Corporation TODAY S AGENDA 21 st Century Cures Law The DC Environment Prior Authorization CRT Separate Benefit Initiative 21 ST CENTURY CURES ACT Signed into law- December 13, 2016 Payment Relief in Non-Bid Areas July 1-December 31, 2016 payment cuts in noncompetitive bid areas will be retroactively delayed until January 1,

2 21 ST CENTURY CURES ACT CRT Accessory Payment law Extends until June 30, 2017 the competitive bid program-derived payment reductions for accessories used with Group 3 power wheelchairs CMS IMPLEMENTATION Section of the 21 st Century Cures Act Extends until June 30, 2017 the unadjusted fee schedules for Group 3 wheelchair accessories and cushions used with Group 3 complex rehabilitative power wheelchairs 2016 KU fee schedule amounts have been updated by the percent CPI update and will be added to the 2017 DMEPOS fee schedule file Suppliers should continue to use the KU modifier for dates of service January 1, 2017 through June 30, Group 3 complex rehabilitative power wheelchair bases: HCPCS codes K K0864 CRT ACCESSORY NEXT STEPS CRT Accessory Payment Bills House and Senate bills to be reintroduced Last Congress: S 2196/HR 3229 Opportunity for Administrative Fix AAH-NCART letter Details current legal authorities Fix: Change to current FAQ 2

3 MEDICAID PAYMENT CUT Medicaid pay-for included in same package Advances by one year the previous law to October 1, 2018 (instead of January 1, 2019) Will limit the federal portion of Medicaid state fee for service DME rate to local bid rate Impact varies by states some but not all are higher than Medicare States already have the authority to do same Not something industry agreed to The D.C. Environment NEW CONGRESS, NEW PRESIDENT 115 th Congress Republicans control House Rs netted -6, Ds netted +6 Republicans control Senate Rs netted -2, Ds netted +2 But: need 60 Senate votes to avoid filibuster A Republican President/Administration 3

4 WHAT TO EXPECT FROM CONGRESS Future of Obamacare? Political hurdles: repeal & replace, costs, insurance lobby, tough to get rid of mandates and keep the popular preexisting condition and 26 and under policies, leave 20M uninsured? Republican plan to use reconciliation requiring only 50 Senate votes Trump s pledge to Modernize Medicare =? Medicaid and the States (AR, IN & KY) - Block grants instead? THE TRUMP ADMINISTRATION HHS Secretary Nominee Tom Price CMS, FDA, CDC, NIH, etc. HME Champion in the House Led HME industry s effort to replace Medicare s DME competitive bidding program with a market-based auction: Market Pricing Program Significant Administrative authority Opposes many CMMI demos and PAC reforms DROP IN CRT PROVIDERS Year Companies Locations ,340 1, ,212 1, ,036 1, ,219 Cumulative 40% 30% *Source: NCART analysis of 4 years of Medicare utilization of 5 CRT base HCPCS codes: E1161, K0005, K0848, K0856, K0861 4

5 Prior Authorization CMS PMD PA DEMO Current program began September 1, 2012 Began as a 3-year program to end August 31, 2015 Began in 7 states (CA, FL, IL, MI, NC, NY, TX) 47% of PMD Claims October 1, CMS added 12 more states (AZ, GA, IN, KY, LA, MD, MO, NJ, OH, PA, TN, WA) 19 States represents about 75% of utilization August CMS announced 3-year extension through August 2018 CMS to expand nationally under CMS PA Rule PRIOR AUTHORIZATION - CMS Final Rule published December 2015, effective February day advance notice via Federal Register CMS Master list of 135 Items Required Prior Authorization List May be regional or national Based on PMD PA Demonstration In and out of CBAs 5

6 PRIOR AUTHORIZATION - CMS In addition to Power Mobility (including Group 3), Master List includes: E1390 K0004 E0193 E0260 E0277 E0371 E0372 E0373 E0470 E0601 E2402 Oxygen concentrator High strength, lightweight wheelchair Powered air flotation bed (low air loss therapy) Hospital bed semi-electric w/ matt Powered pressure-reducing air mattress Non-powered advanced pressure reducing overlay for mattress Powered air overlay for mattress, standard Non-powered advanced pressure reducing mattress RAD, bi-level pressure capability, without backup CPAP NPWT electrical pump, stationary or portable PRIOR AUTHORIZATION FOR 2 GROUP 3 CHAIRS CMS December 2016 Web Site Posting Two Group 3 chairs will be subject to Prior Authorization K0856 and K0861 But doesn t include accessories March 19, 2017: NY, IL, WV, MO July 1, 2017 National PRIOR AUTHORIZATION ON THE HILL Last Session: H.R. 2437: Led by Rep. Marsha Blackburn (R-TN) PA for high dollar DME items Would exempt from pre- and post-payment audits for DMEPOS items that have already been approved through a prior authorization process Pre-approved items could only be subject to audits for fraud and abuse purposes Intent is to reduce the number of audits on DMEPOS suppliers Intent is to refine and get re-introduced next year 6

7 CRT SEPARATE BENEFIT BILLS H.R. 750, Ensuring Access to Quality Complex Rehabilitation Technology Act, Jan Rep. Rob Woodall (R-GA) Senate bill forthcoming Last Session of Congress: H.R co-sponsors S co-sponsors CRT SEPARATE BENEFIT BILLS 1.Create separate category for CRT within the Medicare program 2.Designate specific HCPCS codes as CRT and allow creation of new CRT codes 3.Eliminate in-the-home restriction for CRT and add functional considerations 4.Increase CRT supplier standards: enhanced ATP staff credential; require repair capabilities 5.Expand clinical evaluation to all CRT mobility 6.Allow nursing home residents to access CRT, if part of move to community residence 7.Completely exempt CRT from Competitive Bidding April 26-27, 2017 NCART FLY-IN 2017 National CRT Leadership & Advocacy Conference Presented by NCART and NRRTS 7

8 MEGAVOTE Do you track your federal legislators votes? MegaVote in search engine Key votes, links to send s, upcoming votes and send before votes to provide comments Congress web site where you can track bills CARA C. BACHENHEIMER EXCLUSIVELY FOR INVACARE CUSTOMERS: DISTILLED & DELIVERED 8