RATC Task Force Looks at Complex Rehab Benefit

ARLINGTON, Va. — Aiming to create a separate Medicare
benefit for complex rehab, the American Association for Homecare‘s Rehab and
Assistive Technology Council has launched a task force charged with
drafting legislation toward that end.

“What we’re trying to do is create a separate category in the
DMEPOS benefit that puts custom rehab in its own category like
prosthetics and orthotics,” explained Tim Pederson, RATC chair and
president/CEO of WestMed Rehab in Rapid City, S.D. “They have their own
accreditation, their own quality standards and their own
certification.”

Pederson said that sets a precedent for complex rehab, which
also has its own accreditation and its own quality standards, “and
we’ve got the [ATP] certifications available through RESNA …
We have all the fundamentals in place.”

The sector was heartened last year when the Medicare
Improvements for Patients and Providers Act carved complex rehab
out of competitive bidding, he noted.

“We were pleased to see the recognition in MIPPA that complex
rehab is a separate service and does not belong in competitive
bidding,” Pederson said. “The next logical step is to draw that
correlation between the specialized nature of what we do and the
specialized nature of a prosthetist or an orthotist. Once we make
our case to the ones that do the regulating, then I think we can
make that [legislation] happen.”

It’s early days for the task force, which Pederson said is made
up of custom rehab providers who also handle orthotics and
prosthetics. Other members include Tim Hatt of Wright &
Filippis and John Letizia of Laurel Medical
Supplies in Ebensburg, Pa. Pederson said he has already spoken
with Gary Gilberti, president of the National Coalition
for Assistive and Rehab Technology, about working together on
the project.

“We want to work hand-in-hand with NCART,” Pederson said. “This
is one of their priorities, as well.”

He also hopes to gain the aid of the American Orthotic and
Prosthetic Association, as well as patient advocacy groups.

Pederson said he expected the process to take about two years as
task force members review quality standards and accreditation and
certification processes. Part of that effort will also be to define
and clearly articulate why the benefit needs to be separate, he
said.

“A change in status from supplier to provider is not one of our
goals,” Pederson said. “Prosthetics and orthotics providers are
considered DMEPOS suppliers and they are treated very well, so I
don’t think that being called a provider is any protection.

“The thing to keep in mind is that orthotics and prosthetics is
complex,” he continued. “Complex rehab is more complex than that.
There are more variables. Orthotics and prosthetics has its act
together. You don’t hear about fraud issues with orthotics and
prosthetics. And you don’t hear about it with complex rehab. We
deserve to be judged on our own merits and not the merits of the
rest of the industry, just like orthotics and prosthetics.”

Pederson said the task force efforts “will be a very transparent
process. We don’t want any surprises,” he said, and consensus
within the industry will be essential. “This is a task worth doing
well. I don’t want a do-over.”

While there are legislative and regulatory hurdles that must be
overcome, Pederson said, “We’ve laid the groundwork and we’re ready
to move forward. We want to get this done.”