Committee Readies for Next Steps on Complex Rehab Benefit

BUFFALO, N.Y. — Members of a steering committee charged
with creating a separate complex rehab benefit are looking to avoid
some of the infighting that plagued oxygen providers in recent
policy battles. In two Webinars held Monday and Tuesday, Don
Clayback, executive director of NCART and chairman of the
committee, updated listeners on activities involved with the
effort.

Getting input from stakeholders has been the key to avoiding
strife as the committee looks to accomplish five key goals:

1. clearer and more consistent coverage policies;
2. tighter provider standards;
3. recognition of depth and cost of product-related and clinical
   services required;
4. future payment stability; and
5. an improved model for Medicaid and other payers to follow.

With an eye on fostering agreement, things continue to go well.
“I believe the oxygen folks thought they had consensus to move
forward with their plans, and they found out the hard way that they
did not,” said Tim Pederson, a member of the steering committee and
CEO of WestMed Rehab, Rapid City, S.D. “We are mindful that a great
deal of consensus must be built in the industry before we can move
forward. We are being extremely cautious making sure we have
adequate feedback from all segments of the complex rehab industry.
I have never seen a more collegial process in all my years in this
industry.”

Currently the committee is developing a “working definition” of
complex rehab — one of the basics on which a separate benefit
for the sector would be based. The definition encompasses not only
the products but also the individuals and diagnoses that require
complex rehab as well as the clinical and technological functions
and the professionals involved in its provision.

As the long-term endeavor continues, Clayback stressed that
industry advocates can’t be the only ones carrying the torch.
Instead, gaining the consumer perspective will be a key point in
the group’s action plan as it pursues both regulatory and
legislative paths A centralized Web site (currently in the works)
will help in these efforts and serve as a knowledge base for both
patients and professionals.

“One-on-one conversations on a local level are vital,” added
Clayback. “One-on-one with providers and referral services and
one-on-one with providers and their customers. We’ll be creating
tools to help that.”

During Tuesday’s Webinar, Clayback reiterated that Group 2 power
wheelchairs were not part of the group’s efforts.

“Based on the performance characteristics of Group 2 devices,
NCART has always taken the position that none of the Group 2
category products would be appropriate for people with
disabilities,” added Rita Hostak, committee member and vice
president of government affairs for Sunrise Medical.

“When you look at our definition, it really gets into the
equipment itself, the types of individuals who use the equipment,
as well as the process by which that equipment is provided. Just
looking at the population of individuals that need complex rehab
and the medical necessity that they typically exhibit, we just did
not feel like the Group 2 performance met that
qualification.” 

The steering committee continues to gather feedback, members
said, and has scheduled a Dec. 8 meeting in Nashville to provide an
update on the next steps in preparation for legislative and
regulatory action.