Liberating Complex Rehab

8 Reasons to Support the “Separate Benefit” Effort

Q&A with Don Clayback, Executive Director, NCART

In the September issue, we introduced this “Liberating Complex Rehab”
column to track the progress of the effort to establish a separate benefit
category for complex rehab technology and services. This month, Don Clayback
— NCART executive director and chair of the separate benefit steering
committee — continues his discussion of the effort and how providers can get
involved. For part I of the article, visit — Ed.

#6: The effort will address the issue of complex rehab funding.

Admittedly, bringing up the funding part of this effort can cause some
consumers, referral sources and payors to jump to the wrong conclusion: That
the push for a separate benefit category for complex rehab technology is solely
about increasing earnings for providers rather than also being about ensuring
consumer access to this equipment.

The separate benefit effort does, indeed, address funding. And Clayback
acknowledges that that can be an issue. “In my discussions with some
consumer groups, you’ve got to kind of work through ‘Well it’s not really an
access problem, it’s a business problem.’ And I think it’s critical to say there
really isn’t a difference.”

He explains, “If there’s a reimbursement problem, that’s going to create an
access problem because you’re not going to have providers willing to provide
these products. As the number of suppliers goes down, competition goes
down, and the availability of these products goes down as a result of that.”

Still, Clayback acknowledges the funding issue is a potentially tricky one to explain to the rest of complex rehab’s stakeholders.

“You don’t want to necessarily lead with ‘We need to increase rates’
or ‘We need to reduce further cuts,’” he says. “But you can’t ignore that.
Unfortunately, sometimes people don’t want to talk about it per se, because
That’s a ‘business’ issue, and as a consumer, I can’t really get into that. And
we’re trying to say, ‘We need you to get into that, because we can only carry
the message so far, and at the end of the day, we’re in business to take care of
your needs. If we can collaborate, it really should be a win-win for everybody.”

Improved funding for competitive rehab technology and related services
would enable more providers to continue to serve their clients, which would not
only help to maintain consumer access, but also preserve consumers’ choices of
which providers they want to work with.

“Competition in the U.S. marketplace is what drives customer service,”
Clayback points out. “It drives product development, and without that competition
factor, without that strong group of companies, you as the customer — I
think you suffer.”

#7: Complex rehab providers would be held to different standards.

Part of the separate benefit effort is devoted to specifically defining which groups of HCPCS codes would be defined as complex rehab technology. Going hand in hand with that would be additional standards for professionals who provide that equipment.

“For these specific HCPCS codes, you have to be an accredited complex rehab provider to provide them,” Clayback says. “So if you’re a standard mobility provider, you can certainly do some power mobility. But for example, for Group 3 (power chairs) and above, they would be classified as complex rehab codes. You would have to be a complex rehab provider — which doesn’t mean you would have to have a whole different accreditation, but it would mean that under your DME accreditation, you have been designated as meeting some additional criteria.”

Clayback says those “additional criteria” would likely involve service requirements: “The company, we feel, has to have certain repair and service capabilities and commitments over and above what’s currently out there. There has to be a firm commitment that you service what you sell, whether that be directly in house or you have a service agreement with a recognized, credentialed person.”

Another requirement would center around “the handling and the credentialing of the ATP. We’ve coined the phrase ‘RTP,’ rehab technology professional, just to keep it generic, whereas the ATP is the RESNA credential, and we have the CRTS from NRRTS. The rehab technology professional has to have certain credentials and skills, so we need to identify that.”

Clayback explains that four work groups are currently working on the separate benefit effort. “There’s products and coding, which is about making sure the right technology is being offered,” he says. “There’s coverage and documentation, again a consumer thing to make sure coverage is not limiting people unfairly. For example, if there’s a coverage policy that says you have to have this diagnosis, we’re looking to expand that in consideration of the functional needs of the person, not just a specific diagnosis.

“The third category is payment, and that certainly applies to the supplier’s business, but again, it has a direct relation to access. And then the fourth category is quality standards. There are some things that need to be fixed. In some cases there are some things that quality companies are doing, but not everybody’s doing them, so it presents an unfair playing field where some people are really devoted to good repair service, for example, and others who are saying, ‘We don’t do repairs; go down the street.’ Well, that’s not fair to the consumer, nor is it fair to a supplier who’s made that investment (to provide service). So we’re really trying to raise the bar based on what we’re talking about: that this is complicated equipment, it requires specialized training, and it requires ongoing support. It’s not just any company that should be able to provide it.”

Of the providers he’s spoken to thus far, Clayback says, “We are adding some additional requirements, and I think to their credit, suppliers are willing to take those. But we’re hearing, ‘We cannot take any more additional regulations or requirements unless we can improve the business environment. All these things you’re talking about, we support you, we’d be willing to adopt those, but we can’t just increase the service and credentialing requirements without having some improvements in these other areas.’”

#8: Here’s an opportunity for the complex rehab industry to help shape its own destiny.

An effort this size, obviously, will require significant support and participation from all stakeholders. At this formative stage, Clayback says, “We need people to make sure they’re aware of what’s going on. We’re still in the ‘Here’s where we’re heading, what do you think?’ stage. What do you like, are we missing something, do you have concerns? We’re getting more opportunities on the clinician and the consumer side now, but purposely we have focused on the supplier side in the initial few months because we wanted to make sure that the ‘industry’ was supportive of this idea.

“ I think we’ve gotten good support and good feedback and questions on particulars. Like anything of this nature, I think the devil’s in the details. You talk to somebody about ‘We want to get better recognition for complex rehab technology.’ Yeah, that sounds good. ‘We want to get better policies and better payments,’ and that all sounds good. But what am I committing to as a supplier, what is it going to mean to my customers? So the first step would be: Are you as informed as you need to be so that you either have taken a position that you’re supportive of, or you’ve given your feedback on what thoughts you have and can communicate with any of the steering committee members?”

Clayback also suggests having “some general discussions” with clients so they’re aware of the effort you’re undertaking on their behalf as well as your own. Their support will be critical as the separate benefit effort progresses.

“To make this happen, it’s going to require two pathways,” he says. “One is the legislative pathway to get Congress to pass what they have to from a statutory perspective. Once that law is passed, then it’s turned over to HHS (Department of Health & Human Services) and CMS (Centers for Medicare& Medicaid Services), and it’s their job to implement a separate benefit. Both of those are critical. From a big picture perspective, we’ve had some initial discussions with Congress, some initial support. We’re now looking at crafting the legislation that will get translated into a bill that we would like to get introduced sometime this year. That’s the point where we’d be working in more detail with the consumers, to get them to contact their members of Congress to support this bill, and get it introduced and passed.”

Stay tuned to this column for more information on how you can personally support the complex rehab separate benefit effort — and visit for updates as well.

This article originally appeared in the October 2010 issue of Mobility Management.

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