PSCs Dump Requirement for ATP Evaluation of PWC Benes
BALTIMORE–CMS’ DME Program Safeguard Contractors have
eliminated a requirement for a certified Assistive Technology
Practitioner (ATP)–a credential bestowed by the Rehabilitation
Engineering & Assistive Technology Society of North America–to
evaluate beneficiaries receiving certain power wheelchairs.
Scheduled to take effect April 1, 2008, the requirement was
included in the LCD for power mobility devices. But a bulletin
published Wednesday said “after consideration of the issues, the
PSCs have decided to remove this requirement from the policy.”
Instead, the three medical directors for the PSCs said the
current evaluation requirement would remain in place: Patients must
have “a specialty evaluation that was performed by a
licensed/certified medical professional, such as a PT or OT, or
physician who has specific training and experience in
rehabilitation wheelchair evaluations and that documents the
medical necessity for the wheelchair and its special features.”
The specialty evaluation applies to patients receiving a Group 2
single- or multiple-power option power wheelchair, any Group 3 or
Group 4 PWC or a push-rim activated power assist device for a
manual wheelchair.
The PSCs also will retain a requirement that the equipment come
from a supplier employing a RESNA-certified Assistive Technology
Supplier (ATS) “who specializes in wheelchairs and who has direct,
in-person involvement in the wheelchair selection for the
patient.”
The revision came in response to requests from the American
Occupation Therapy Association, the American Physical Therapy
Association and the American Association for Homecare to reconsider
the LCD.
“Without such action, the independent ATP requirement would have
… caused significant access issues for patients” due to the
“significant shortage of OTs and PTs with the ATP credential in
many parts of the country,” said Seth Johnson, vice president of
government affairs for Exeter, Pa.-based Pride Mobility Products
and a member of AAHomecare’s Rehab and Assistive Technology
Council.
“Our goal was simply to delay the implementation of the
requirement to provide time for OTs and PTs to get that
certification,” he continued. “We do see the need for that
credential. The way that the medical directors ultimately decided
to address the shortage issue doesn’t eliminate permanently the
need for some type of independent certified therapist to have a
role in the provision and the evaluation of the patient for this
equipment.”
Nothing precludes the medical directors from monitoring the
situation and adding the requirement back to the LCD at a future
date, Johnson said. “But as far as addressing the immediate need,
everyone agrees this decision by the medical directors does
accomplish that goal.”
Although RESNA expanded its testing schedule for the ATP and ATS
exams this year, the total number of people credentialed at the end
of October was 2,812. Of those, 1,138 are ATSs and 1,674 are
ATPs.
“This would have created a real access issue and a backlog for
consumers, especially in rural areas,” said Gary Gilbert, president
of Chesapeake Rehab Equipment, Baltimore, and vice president of the
National Coalition for Assistive and Rehab Technology. “Some will
argue that this is a setback for controlling the quality of the
evaluation and delivery process. I believe that the quality will be
maintained by having certified suppliers–ATSs–and OTs and PTs who
are proficient in seating and mobility involved in the
process.”
He added removing the ATP requirement “means that the current
supplier-referral relationships will continue and there will not be
severe dips in the revenue stream while we try and divert the
referrals to those few clinics that employ ATPs.”
“I think it’s a good thing,” said Don Clayback, vice president
of government relations for The MED Group, Lubbock Texas. “The
bottom line is this decision had to be made because there just
weren’t enough people to make it happen, and at the end of the day,
the beneficiary is still protected. You still have to have a
knowledgeable PT or OT involved in the process and a credentialed
ATS on the supplier side.
“It’s a step up from where things were,” Clayback said. “The
difficult thing both financially and time-wise is we do have
therapists who sat for the exam. But that’s a credential they can
use, and it does distinguish them.”
According to Tim Pederson, ATS, CEO of WestMed Rehab in Rapid
City, S.D., and chair of AAHomeCare’s RATC, the Council had asked
that the ATP requirement be phased in over a three-year period to
allow practitioners additional time to get certified.
The 200-question RESNA ATP exam costs $500.
“Now we are hearing that reimbursement is being reduced for the
therapists who conduct wheelchair evaluations. It is highly
unlikely that we would have an adequate number of ATPs no matter
how long the requirement is phased in,” Pederson said. “Therapists
are unlikely to take the time and spend the money to test for the
ATP credential because of the substantial reduction in
reimbursement proposed by CMS for those therapists who do this
work.”
Indeed, not everyone is convinced removal of the ATP requirement
is a good thing.
Simon Margolis, executive director of the National Registry of
Rehabilitation Technology Suppliers–a registry of professionals
with the RESNA credential–said he felt the complex rehab and
assistive technology profession had been “sold out.”
According to Margolis, a past president of RESNA, “the typical
curriculum of a PT or OT school includes little or no training in
this area.”
“In general we’re disappointed with the medical directors’
decision,” said Glenn Hedman, RESNA’s current president and
director of the Assistive Technology Unit at the University of
Illinois, Chicago. “We did greatly expand our number of exam
offerings in 2007, and that schedule continues into 2008. We felt
very strongly that the professionals on both the ATP and ATS sides
were responding to the regulation and showing strong interest in
obtaining the credential.
“We have been in communication with the medical directors,”
Hedman continued, “and do hope that they revisit the requirement in
the future, as we feel it does help identify qualified
professionals to perform the power mobility evaluations.” Hedman
said the RESNA Professional Standards Board is currently
considering development of another specialty credential in seating
and mobility.
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