Tuesday, January 26, 2010

BUFFALO, N.Y. — The project steering committee continues work on development of a separate Medicare benefit for complex rehab and, according to Don Clayback, committee chair, they're making progress.

"It's all about access to the products that fall under the complex rehab technology banner," Clayback said. "As providers know, as individual clinicians know and as consumers know, there are some barriers that prevent these products and services from being provided, and we're looking to address those."

The group began work on the concept last year, and since has held conference calls, Webinars, a panel discussion at Medtrade and in-person meetings in St. Louis and Nashville to gather input from stakeholders across the HME mobility sector.

"It's a very big project with a lot of details and nuances that need to be addressed," said Clayback, executive director of NCART, during a Jan. 22 update. Each of the three major components that will shape the separate benefit proposal — coding, coverage and payment — takes thought from every angle, including how any changes might impact the current system, "and we don't want to rush through," Clayback said.

The massive effort is paying off, he believes. Past identifying the big-picture objectives for a new rehab benefit — among them recognition of the services involved with providing complex rehab — the group is now working on fixes in five specific areas: fee schedule, coverage and conditions for payment, coding, claims processing and provider qualifications.


Details of the proposed changes will be finalized at a committee workgroup meeting Feb. 1 and 2 in St. Louis, and the results will be incorporated into a draft white paper to be released at the committee's next Webinar, scheduled for March 4.

Coding is a particular challenge "because CMS has had such a tendency over the last five years or so to bundle items," noted committee member Rita Hostak, vice president of government relations at Sunrise Medical. "The industry has suffered a lot financially by these groupings,"  she said, "so what we did as a coding workgroup was to take a step back and list everything that is potentially HCPCS-related to wheeled mobility and seating under a benefit category called complex rehab."

That includes not only bases but also accessories, said Hostak, and that gets into a discussion about "what is DME vs. what's truly complex rehab … Anybody that can provide complex rehab could provide DME, but the opposite may not be true." Hostak said her workgroup put together a matrix to sort it all out "that gave us a different way to look at these codes."

Discussion of a draft code list will continue at the workgroup meeting next week.

The committee is also looking at the best structure for coverage changes in terms of power mobility, manual mobility and seating, Clayback added.


The steering committee is "really looking at finding the right balance" between making changes "that will get the improvements that we desire while at the same time not adding any unnecessary complexity or cost to the system … A lot of variables come into that analysis, and that's where the discussion is now," he said.

Related issues, such as elimination of the "in-the-home" restriction, provider standards and credentialing and service and repair are also being considered. "There have to be safeguards to make sure consumers are getting the right services and right evaluation," Clayback said.

In the end, he said, one of the "intangibles" he hopes to come from creation of a separate benefit "will be a greater appreciation for the role and the services that a complex rehab provider gives to their community."

A recording of the Jan. 22 update should be available shortly, Clayback said. In the meantime, comments to any member of the steering committee are welcome: