One Step Forward on Rehab Benefit, One Step Back on First-Month Purchase Option

NASHVILLE — Members of a steering committee pushing ahead
on a Medicare complex rehab benefit found out early this week that
the so-called “clawback”
proposal, another issue on the rehab sector’s agenda, is
out.

The proposal had been devised to preserve the first-month
purchase option on Group 2 and below power wheelchairs; elimination
of the option is currently included in both House and Senate health
reform plans. Under the  proposal, “if for some reason the
patient would die before 13 months had passed since they got the
wheelchair, then the government in effect would ‘claw back’ however
many months of rental that was worth,” explained Tim Pederson,
chair of AAHomecare’s Complex Rehab and Mobility Council and a
member of the steering committee.

But according to Pederson, the industry plan “did not survive
the Congressional Budget Office score. It scored $200 million over
10 years, which is about $600 million short of what they believe
they would get if they eliminated the first-month purchase
option.”

Now the sector is hoping to come up with another fix. “We are
working with Sen. Arlen Specter’s (D-Pa.) office on an alternative
proposal,” said Pederson, CEO of WestMed Rehab in Rapid City,
S.D.

Regarding creation of a separate complex rehab benefit, the
steering committee members looked at coding, coverage, payment and
medical policy during a two-day meeting Dec. 8 and 9. Pederson said
the group had convened to hammer out a firm approach this week
before going to CMS and Congress, but decided that rushing it would
ultimately be a disservice. “We must have broad-based buy-in from
the entire industry or we are going to end up like the oxygen
coalition,” he said. “Fortunately, there is nothing that divides
us.”

So far, getting input from
rehab 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 the 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.

As for the massive health care reform bills being debated in
Congress, Pederson believes it is naive to think that the reform
issues won’t affect complex rehab efforts in some way, but
determining those effects is difficult. “It is not going to change
our ultimate goal, which is to achieve a broad-based definition of
what is complex rehab,” he said. “I think that goal is entirely
consistent with health care reform.”

As the long-term effort continues, Don Clayback, executive
director of NCART and chairman of the committee, has stressed that
the usual suspects can’t be the only ones carrying the torch.
Instead, seeking out consumer opinions will be a key part of the
group’s developing action plan. NCART’s newly updated Web site includes
information on creation of the new benefit as a knowledge base both
for patients and professionals.

After the action plan is settled, committee members will ask for
additional feedback from stakeholders via a series of conference
calls and/or Webinars currently planned for January.