ARLINGTON, Va. — Aiming to create a separate Medicare benefit for complex rehab, the American Association for Homecare's Rehab and Assistive Technology Council has launched a task force charged with drafting legislation toward that end.
"What we're trying to do is create a separate category in the DMEPOS benefit that puts custom rehab in its own category like prosthetics and orthotics," explained Tim Pederson, RATC chair and president/CEO of WestMed Rehab in Rapid City, S.D. "They have their own accreditation, their own quality standards and their own certification."
Pederson said that sets a precedent for complex rehab, which also has its own accreditation and its own quality standards, "and we've got the [ATP] certifications available through RESNA … We have all the fundamentals in place."
The sector was heartened last year when the Medicare Improvements for Patients and Providers Act carved complex rehab out of competitive bidding, he noted.
"We were pleased to see the recognition in MIPPA that complex rehab is a separate service and does not belong in competitive bidding," Pederson said. "The next logical step is to draw that correlation between the specialized nature of what we do and the specialized nature of a prosthetist or an orthotist. Once we make our case to the ones that do the regulating, then I think we can make that [legislation] happen."
It's early days for the task force, which Pederson said is made up of custom rehab providers who also handle orthotics and prosthetics. Other members include Tim Hatt of Wright & Filippis and John Letizia of Laurel Medical Supplies in Ebensburg, Pa. Pederson said he has already spoken with Gary Gilberti, president of the National Coalition for Assistive and Rehab Technology, about working together on the project.
"We want to work hand-in-hand with NCART," Pederson said. "This is one of their priorities, as well."
He also hopes to gain the aid of the American Orthotic and Prosthetic Association, as well as patient advocacy groups.
Pederson said he expected the process to take about two years as task force members review quality standards and accreditation and certification processes. Part of that effort will also be to define and clearly articulate why the benefit needs to be separate, he said.
"A change in status from supplier to provider is not one of our goals," Pederson said. "Prosthetics and orthotics providers are considered DMEPOS suppliers and they are treated very well, so I don't think that being called a provider is any protection.
"The thing to keep in mind is that orthotics and prosthetics is complex," he continued. "Complex rehab is more complex than that. There are more variables. Orthotics and prosthetics has its act together. You don't hear about fraud issues with orthotics and prosthetics. And you don't hear about it with complex rehab. We deserve to be judged on our own merits and not the merits of the rest of the industry, just like orthotics and prosthetics."
Pederson said the task force efforts "will be a very transparent process. We don't want any surprises," he said, and consensus within the industry will be essential. "This is a task worth doing well. I don't want a do-over."
While there are legislative and regulatory hurdles that must be overcome, Pederson said, "We've laid the groundwork and we're ready to move forward. We want to get this done."