From RATC’s Perspective

Much attention has been given to the concept of creating a distinct and separate identity for complex rehab. Various organizations in the complex rehab community have been discussing, debating and strategizing about the best way to move this effort forward.

AAHomecare’s Rehab and Assistive Technology Council has convened a work group dedicated to the issue, and it has combined efforts with a similar group from the National Coalition for Assistive and Rehab Technology (NCART). The question the industry faces is what is the best way to get this important goal accomplished? The RATC view is that we have three choices: a regulatory approach, a legislative approach or a combination of the two.

On the surface, legislation seems to be the perfect solution. We just need to march up to Capitol Hill, ask for legislation, get it passed and all will be well in the realm of complex rehab. In reality, nobody in our industry can look at our legislative record and point to any unqualified success.

We need a legislative surgical strike, but legislation is messy because legislative initiatives must pass both houses of Congress intact. Legislation also carries significant risk of unintended consequences due to floor debates and amendments added in final markup. It is likely that our intended legislative solution would look nothing like the final law that is passed.

Even if we get a perfect bill passed by Congress and signed into law, the devil is in the details of implementation through the regulatory process. For example, while none of us is enthusiastic about surety bonds, the legislation creating the surety bond requirement was passed by Congress in 1997. After 12 years, CMS has finally implemented the requirement.

If we pass legislation in its most perfect form, we cannot wait 12 years for a reformed complex rehab benefit.

The RATC’s view is that we must make preparations for a legislative strategy, but we must first attempt a regulatory solution through HHS, CMS and the DME MAC medical directors. A regulatory solution has greater potential to be surgical in nature because it does not need to go through the congressional process. This helps to preserve the original intent of the initiative.

The complex rehab community can point to some significant regulatory successes in the recent past. For example, the quality standards for accreditation specifically require that “the supplier shall: Employ (W-2 employee) at least one qualified individual as a Rehabilitative Technology Supplier (RTS) per location.”

The standard then defines a qualified individual as possessing the ATP or CRTS credential. This requirement has been seen by some in the industry as a hindrance. It is quite the contrary. Some in the prosthetics and orthotics industry have been working for years to achieve this recognition, and it has eluded them.

If we ignore the revised reimbursement for power mobility from November 2006, the power mobility LCDs also represent a significant development. These medical policies stipulate that complex services must be provided by a qualified individual with the ATP credential from the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).

Medical policy is written by the DME MAC medical directors. It is clear that the medical directors recognize the specialized nature of complex rehab, and my conversations with some of them confirm their belief that complex rehab is a distinctive service.

As an industry, we do not realize the significance that these regulatory accomplishments have had in our quest for a separate and distinct identity for complex rehab. We must build upon these accomplishments and take them to the next logical step. Our goal can be divided into four tasks:

1. Determine the rationale for pursuing a reformed benefit. NCART has authored a position paper that was used on Capitol Hill during the CELA conference earlier this year. This paper can be adapted to create two additional documents, one for discussions with clinical groups and one for discussion with non-clinical groups.
2. Define and develop a distinct complex rehab medical policy and benefit. We must build upon the accomplishments of the power mobility LCDs by working with those who develop medical policy to create policies for complex rehab services not covered under the power mobility LCDs.
3. Examine the coding and payment system to ensure that they reflect a reformed benefit. We may need to live with our current coding and payment system until CMS adopts a revised payment methodology that is no longer tied to the gap-filling method.
4. Determine quality standards and accreditation. We must further refine the existing quality standards and accreditation process to reflect industry best practices.

Finally, we need to work with CMS to find an editing mechanism for front-end claims processing. An indicator should be tied to a provider’s NPI number, which will indicate to the DME MAC that a provider is qualified to provide complex rehab services. Pharmacies that are qualified to provide nebulizer medications under Part B have a similar indicator attached to their NPI number that tells the DME MAC the pharmacy is qualified to provide that service.

The complex rehab industry has achieved its evolutionary accomplishments through the perseverance of NCART, the RATC, the National Registry of Rehabilitation Technology Suppliers (NRRTS) and RESNA. The industry must unite and focus on accelerating the evolutionary process to be recognized by our regulators and policymakers as the specialized providers of care that we have become.

The combined resources and collaborative brain power of all of our stakeholders should be more than sufficient to accomplish our important goal. If we fail, we have the legislative strategy as a fall-back position.

Read more AAHomecare Update columns.

Tim Pederson, ATP, is CEO of WestMed Rehab, Rapid City, S.D., chairman of the American Association for Homecare’s Rehab and Assistive Technology Council and president of the Midwest Association for Medical Equipment Services. You can reach him at 605/342-7004 or [email protected].