Conference Moves Rehab Sector Forward on Separate Benefit

ST. LOUIS — Complex rehab stakeholders who gathered in St.
Louis last week to talk about a separate complex rehab benefit left
the all-day consensus conference with three main take-aways: It
needs to be done, there is much work yet to do and it is
doable.

That was good news for the Complex Rehab Steering Committee,
which hosted the conference and got the green light from some 50
attendees to go ahead with efforts to redefine the complex rehab
Medicare benefit.

“I would say the biggest message was, ‘You guys are on the right
track.’ We had consensus that this is something we need to do,”
said Don Clayback, executive director of the National Coalition for
Assistive and Rehabilitation Technology Suppliers and a member of
the steering committee.

The event offered stakeholders the opportunity to express their
concerns and comment on the work of the steering committee and its
work groups, which focused on such issues as fee schedule and
coding, medical policy, claims processing and provider
qualifications.

“We’re trying to flesh out the details through the industry so
that we can put those details together into a plan to create a
redefined benefit for complex rehab,” explained Tim Pederson, CEO
of WestMed Rehab in Rapid City, S.D., and chair of the American
Association for Homecare’s Complex Rehab and Mobility Council.

He added, “I don’t see us taking it out of the DMEPOS benefit.”
Instead, he and Clayback said, a reconfigured benefit might look a
lot like the orthotics and prosthetics benefit that falls under
DMEPOS.

“They are under the DMEPOS category, but they have their own
coverage criteria,” Clayback said.

One of the key issues of the day was the definition of complex
rehab. “There is broad agreement on all the bullet points that
define complex rehab; however, we have not been able to reach
consensus in the industry on the wordsmithing of the definition,”
Pederson said. “There was some division on the steering committee
on whether we should focus on the technology for the definition or
[on] the process,” he continued. “Is it the products or the
process? What we determined is that it is both. We really can’t
define one without the other. So we are going back to the drawing
board and try again.”

Clayback said the definition would ultimately cover
technology/products, users, the process and qualifications of
people involved in the process.

Other discussion centered on how the industry can work with CMS
and its contractors to change the regulatory arena and elevate the
industry, Pederson said.

“There are certain items we are going to pursue through the
regulatory process and certain items we are going to pursue through
the legislative process,” he said. “One of the main things we can
do with CMS is to develop a front-end mechanism that identifies a
complex rehab supplier, which we don’t have right now.”

While quality standards require that a RESNA-certified ATP be
involved in the wheelchair selection for a patient, Pederson said,
“right now, there is no edit system in place to identify whether an
ATP was involved.”

National Supplier Clearinghouse forms do not have any way to
document that the provider is a complex rehab supplier, he noted.
“It seems silly to have that requirement and not have a way to
document it,” Pederson said.

Stakeholders are also concerned, he said, that the complex rehab
provider qualifications and accreditation need “some teeth.”

“Even though we have quality standards, there is a degree of
separation on the application of those standards, and among the
surveyors, there are varying methods. We need a little more
uniformity and a more robust process,” Pederson said.

As well, he noted, a RESNA registry of certified ATPs would be
helpful. “We came up with recommendations for RESNA, the NSC,
accreditation bodies and for the DME MACs that we can do now and
they will immediately elevate our industry exponentially,” Pederson
said.

Clayback said it was likely some issues would require
legislative action. “So we are looking now toward legislation,
identifying champions, doing more outreach to the consumer and
clinician sides,” he said. “We are looking at probably a two-year
project from legislation to implementation and operation. Some of
the changes could go into effect in 2011.”

The conference was the fourth in a series of events sponsored by
the steering committee — including two Webinars and a session
at Medtrade — to gather feedback, and other Webinars are
planned.

“The go-forward plan … is to pull all that together into a
summary document with a proposed definition that people will be
able to comment on,” Clayback said. “We will be creating kind of a
white paper that will flesh out some of these details, and we will
be sharing it with the industry and other groups through Webinars
later this month.”

The goal of the steering committee, he stressed, is to be
transparent in its work, to invite input from every stakeholder and
to draft a plan that will generate consensus.

“I truly think there is going to be consensus in the industry,”
said Julie Piriano, director of rehab industry affairs for Exeter,
Pa.-based Quantum Rehab. “I’m really looking forward, once we get
this defined, to looking for legislative champions to take the ball
and run with it so we can fully effect change to this benefit.”