The Rush Is On

Congress is back in session and election year politicking is upon us. While there is a compressed legislative schedule this year because of elections, there are industry opportunities. Typically legislators are much more attuned to constituent concerns in an election year. That elevates the importance of our continued efforts to reach political leaders.

The four topics covered in this column are neither the only challenges, nor are they the only opportunities for 2012. Further opportunities will be based to a degree upon our collective efforts to educate legislators on problems and solutions. 2012 will require more outreach and meetings—at a time when chances of success are best.

Competitive Bidding

Despite significant and continuing industry efforts to replace competitive bidding with the more practical Market Pricing Program (MPP), the Round 2 bid window opened Jan. 30. The best opportunity to advance the alternative is the “doc fix” legislation that must pass by March for physicians to avoid a 27.4 percent reduction in Medicare payments.

While legislative efforts remain on advancing the MPP alternative, other efforts will continue on the regulatory front to modify the process and procedures CMS uses to evaluate bid information and determine which providers are offered contracts. Making changes after the close of the bid window, tentatively scheduled for March 30, will be difficult, but there could be opportunities to modify the processes or stop the program before that. 

Power Mobility Device Demonstration

The industry got good news on Dec. 29, when CMS announced the indefinite delay of the pre-payment review and prior authorization demonstration for power mobility devices in seven states. The delay was the result of a strong and unified message from all power mobility stakeholders—providers, consumers, physicians, clinicians, and manufacturers.

Congress and stakeholders encouraged CMS to develop a prior authorization process similar to the one included in legislation—HR 3399, section 204—introduced last year by Rep. Peter Roskam, R-Ill. The bill calls for a comprehensive, face-to-face examination template for clinicians to document specific criteria to determine medical necessity. Stakeholders would be involved in the template-development process.

The industry now has an opportunity to work with Congress, CMS and other stakeholders to move Medicare away from its outdated and inefficient “pay-and-chase” model toward real-time monitoring. If done correctly, this would be in all stakeholders’ best interest, including Medicare.

Separate Benefit for Complex Rehab

Late last year, Rep. Joseph Crowley, D-N.Y., promised to introduce legislation creating a separate benefit category for complex rehab. Our goal is to get the bill introduced before this year’s NCART/NRRTS CELA Conference set for April 17 – 19 in Washington.
This separate benefit would improve and protect access to complex rehab technology (CRT) products and services for people with significant disabilities. Early introduction of the bill will provide time to build support for passage.

Medicaid

At the state level, challenges will continue to present themselves as state legislatures continue efforts to reduce expenditures or slow the growth of Medicaid programs. The industry is more organized and had positive outcomes in some states last year because of increased efforts. In 2012, many state legislators will also be up for re-election, which should make them more attuned to issues raised by constituents.

Since all states have individual Medicaid programs, the best resource for the latest information is your state associations and organizations. Each has resources to get stakeholders more involved in helping protect Medicaid coverage and payment policies.

No matter which issues keep you awake at night, you should feel a sense of opportunity in 2012. Remember, all the politicking that you see in Washington and in your state signals one thing—legislators need your support and are more apt to listen to your concerns.