Rehab Carve-Out Gets Boost from Senate Trio

WASHINGTON–Complex rehab stakeholders got a big boost last week
when three legislators introduced a Senate companion to H.R. 2231,
the House complex rehab carve-out bill.

The Medicare Access to Complex Rehabilitation and Assistive
Technology Act of 2008, S. 2931, was introduced by Sens. Olympia
Snowe, R-Maine, Debbie Stabenow, D-Mich., and Tim Johnson, D-S.D.
Like its House counterpart, the bill would exempt complex rehab
from competitive bidding.

Tim Pederson, CEO of WestMed Rehab in Rapid City, S.D., and
chairman of the American Association for Homecare’s Rehab and
Assistive Technology Council, said the bill was the result of
several years of effort on the part of RATC members.

“It was really tough to talk about the House version of
the carve-out when there wasn’t a Senate companion,” Pederson
said. “And now that we do have the Senate companion, it
should increase support exponentially across the board.”

That could be crucial in the next few months. No one expects the
carve-out measure to pass on its own. Introduced last year by Reps.
Tom Allen, D-Maine, and Ron Lewis, R-Ky., the House version of the
bill has picked up only 40 cosponsors. Instead, the hope is to
package the carve-out with Medicare legislation currently being
hammered out in the Senate. Commonly known as the “doc
fix,” the Senate’s Medicare bill would delay a 10 percent
reimbursement cut for physicians now scheduled for July 1.

“The important thing is that the Medicare legislation is
going to originate in the Senate, not the House this time,”
Pederson noted, “so that’s good, and to already have three
sponsors for the [carve-out] legislation is significant.” He
added that two of those sponsors–Snowe and Stabenow–are members
of the powerful Senate Finance Committee, which oversees Medicare,
and that Johnson is close to Montana Democrat Max Baucus, the
committee’s chairman.

Pederson credited RATC member Jim Greatorex, president of Black
Bear Medical in Portland, Maine, with getting Snowe to sponsor the
bill. He actually got the commitment during the AAHomecare
Legislative Conference in March, Greatorex said.

“We rearranged our meeting time twice to get to speak with
[Snowe] in person,” he said, noting that he had tried in each
of the three previous years but got only as far as an aide each
time. But the persistence paid off. “We had a great meeting
with her. She committed right on the spot … She was supportive of
everything we brought,” Greatorex said.

He added the new Senate bill is proof that if you can get to the
actual member of Congress, “the chances are much greater [of
getting what you want] … Whether these bills go through and
become part of the law or not, it at least shows our industry is
doing something in Washington, and if you go to Washington and
attend some of these fly-ins and conferences, your voice can be
heard.”

Still, while the Senate bill is exciting news to the beleaguered
industry, the work for stakeholders isn’t done, Greatorex said.

“We need to act on this bill quickly because it appears
the only avenue of getting it passed is with the doc fix bill, so
we need to be really active in trying to get the signatures [of
other senators as cosponsors],” he said.

“What we would like to do is have [other] senators talk to
Sen. Baucus and urge [him] to get the legislation added to the
Medicare package,” said Sharon Hildebrandt, executive
director of the National Coalition of Assistive and Rehab
Technology. “We want them to talk directly to Sen. Baucus
about this. That’s how it is going to happen. This bill has to be
important to members of the Senate; that’s how we are going to get
it passed.”

Baucus has already gone on record as saying he wants to delay
physicians’ pay cuts for 18 months and, in addition, give them a
1.1 percent raise. He has also said he wants the Medicare
legislation to expand beneficiary access to preventive care
benefits and primary care, and to offer more financial help for
low-income seniors.

Whether or not Baucus and the rest of the Senate will be open to
other issues is the question, said Michael Reinemer, AAHomecare’s
vice president of communications and policy.

“The [doc fix] patch they approved last year expires June
30, so there is a narrowing window on that,” he said.
“The question is, how wide does it open up to other issues?
That could be a double-edged sword; it could open up to cuts as
well as fixes.”

Pederson said he thinks there is a good chance the carve-out
bill will become a part of the Medicare package this year.

“It’s a benign piece of legislation,” he said.
“Sen. Johnson’s office shared with us that they believe the
score from this bill will be insignificant. A lot of times, when a
bill scores really low, they call it an asterisk. [Sen. Johnson’s
office staff] says this is less than an asterisk. They even called
it ‘budget dust.’”

Hildebrandt said an industry-commissioned study estimated the
carve-out would cost $46 million over five years. “That
hasn’t been scored by the [Congressional Budget Office], but we are
in line to be scored by the CBO and that’s the next step,”
she said.

Under federal mandate, the CBO must estimate the cost to the
government of each bill. In order for a bill to be passed, it must
also include a way to make up for that cost–usually by cutting
from somewhere else.

Hildebrandt said if the CBO finds the $46 million estimate to be
accurate, “it wouldn’t be that difficult to find a ‘pay-for.’
If we can keep it low, we have a pretty good chance of getting on
the package.”

In a statement introducing the bill, Snowe gave her reasons for
joining the carve-out fight:

“Complex rehabilitation and assistive technology products
are a lifeline to severely disabled Medicare beneficiaries who seek
to lead independent and productive lives. Although competitive
bidding may reduce the cost of some health services, it is simply
untenable to include such sophisticated and personalized equipment
in the Medicare competitive bidding program.

“We must ensure that these individuals living with complex
disabilities will have access to the necessary medical equipment
and services to fit their needs.”

To view the full text of S. 2931, go to
http://thomas.loc.gov.