Committee Asks for Feedback on Separate Complex Rehab Benefit

BUFFALO, N.Y. — A 26-page "discussion paper" and four hours of details via two Webinars Thursday kicked off continuing efforts by the project steering committee in development of a separate benefit for complex rehab technology.

The committee's five objectives: 1) clearer and more consistent coverage policies; 2) stronger and more enforceable supplier standards; 3) formal recognition of product-related services and costs; 4) payment stability; and 5) an improved coverage and payment system that can serve as a model for Medicaid and other payers to follow.

"The separate benefit is a major undertaking, but something major is needed to protect the availability of these products and services to people that use them every day of their lives," according to committee member Gary Gilberti, president of NCART. "With this document we can now have the necessary stakeholder discussions with other individuals and groups to develop the plans and actions required."

The discussion paper, in the works since September through the efforts of a 20-person workgroup, essentially gets the ball rolling for comments from all relevant stakeholders.

"This is not a finished product," said Don Clayback, NCART executive director and steering committee chair. "It is meant to be a starting point so stakeholders have some level of detail to review and respond to."

In a Q&A session during each Webinar, listeners did respond with questions and comments related to the plan's major components, which cover:

Products and coding - Current HCPCS codes will be classified as Complex Rehab Technology (CRT) and will only be available through accredited CRT companies. Modifications and additions will be made, as needed, to codes that currently contain both CRT products and non-CRT products to segregate CRT from DME, and new codes will be added for "uncoded" CRT items that are routinely provided but currently do not have an assigned code.

Coverage and documentation - Coverage criteria for CRT will be based on a determination of the beneficiary's functional abilities and limitations instead of specific diagnoses. The primary weight for clinical documentation will be shifted from the physician to the therapist, and Medicare's "in-the-home" restriction would not apply to CRT.