Policy Perspective

Legislative Landscape for Complex Rehab in 2011

• By Seth Johnson
• Mar 01, 2011

The complex rehab industry is starting 2011 in a much different legislative environment than it began 2010.

The historic elections last November have ushered in a new Republican majority and leadership in the House, along with a slimmer majority in the Senate for the Democrats. The most noticeable change in the Senate from a healthcare perspective is the ascension of Sen. Orrin Hatch (R-Utah) to the top Republican position on the Senate Finance Committee. He is replacing Sen. Charles Grassley (R-Iowa), who was known for having a close working relationship with Chairman Max Baucus (D-Mont).

Sen. Hatch is quite knowledgeable on many industry issues, has been a supporter in the past and will play a key role on this important committee as we look to advance industry initiatives.

While this year will certainly be filled with challenges on many fronts, the complex rehab industry in particular appears to be much better positioned than other larger industry segments. Still, it is important to evaluate the opportunities and threats for the complex rehab industry this year and identify what actions will be necessary in order to ensure the industry moves forward in 2011.

Separate Benefit for Complex Rehab Technology

Hopefully by now you are familiar with the proactive separate benefit initiative for complex rehab technology, which is in the early stages of development. The overarching goal is to improve and protect access to complex rehab technology for individuals with significant disabilities and medical conditions. The anticipated outcomes from this effort include:

• Clearer and more consistent coverage policies.
• Tighter provider standards to promote better clinical outcomes and consumer protection.
• Recognition of depth and cost of products and clinical services.
• Future payment stability to ensure continued access.
• An improved model for Medicaid and other payors to follow.

Those supporting this initiative and actively participating on the steering committee include NCART, the American Association for Homecare (AAHomecare), NRRTS and RESNA, along with other clinician and consumer group stakeholders within the complex rehab community.

The CELA conference that occurred in Washington, D.C., in February was focused on building more awareness of complex rehab technology and legislative support for the soon-to-be introduced legislation that will craft the framework for the complex rehab technology separate benefit. In addition, there are task forces under the steering committee focused on development of regulatory proposals relative to coding, coverage, payment and standards for complex rehab technology providers under the separate benefit. Stay tuned for significant updates and “calls to action” in order to advance this initiative as we move through the year.

Competitive Bidding

The good news for complex rehab is that all Group 3 power wheelchairs were exempt from future rounds of competitive bidding.

The area of concern focuses largely on the inclusion of Group 2 complex rehab (power seating options codes) and related accessories that were included, and the threat that the Round 2 product categories (yet to be released as of the writing of this article) could include other types of product categories of concern to complex rehab providers that were not included in Round 1 of the competitive bidding program.

The industry has an opportunity to continue working with both CMS and Congress to secure a removal of the Group 2 codes categorized as complex rehab by Medicare policy prior to the CMS announcement of product categories to be included in Round 2 of the program. The announcement of the product categories, ZIP codes and other pertinent information regarding the start in the process for beginning Round 2 is expected early this year, so timing is of the essence for these efforts.

In addition, DME industry efforts will once again be focused on stopping the program and/or slowing down the timeframe for beginning the Round 2 bidding process, scheduled to begin early this year according to CMS’ published timeframe. It is important to note that the healthcare reform bill passed last year not only expanded the footprint for Round 2 from 79 to 100 areas, but it also requires the Secretary to either expand the competitive bidding program or apply the competitively bid rates nationally by the year 2016.

So what can be done to stop or slow the expansion of competitive bidding? AAHomecare and other state and national associations are extremely focused on collecting the negative outcomes occurring in the nine Round 1 areas in order to demonstrate the magnitude of the problems associated with the competitive bidding program. This is necessary in order to secure some relief this year. If you, your customers, caregivers or referral sources are aware of negative outcomes or have problems, complaints or concerns related to the Round 1 rebid of the “competitive” bidding program, you are encouraged to report these problems to AAHomecare via their Web site (aahomecare.org) or by calling their hotline at (888) 990-0499.

Waste, Fraud & Abuse

Controlling erroneous and inappropriate spending in the Medicare program has been a focus for many members of the House and Senate. In the 111th Congress there was a significant number of ideas brought to the table, numerous bills introduced and several legislative hearings held to ferret out the best way to strengthen anti-fraud measures that never made it into healthcare reform law.

Look for Medicare fraud prevention and enforcement to be a hot-button topic in the 112th Congress, as the wave of baby boomers begins turning 65 and ages into the program this year. While complex rehab has not been a specific target for this type of legislation, changes to how providers participate in federally funded programs (Medicare and Medicaid) in the future will likely impact complex rehab providers as well.

Medicaid Issues

Again this year, Medicaid issues will remain a significant concern for many in the complex rehab industry. Medicaid is a significant payor for complex rehab technology, and in light of the increasing financial pressures from the states, the industry will likely see continued activities to reduce coverage and reimbursement.

In light of this growing issue, last fall NCART convened a National Medicaid Summit. The meeting included strong representation from providers, manufacturers and state association leaders interested in a common goal: protecting coverage and payment for complex rehab technology.

The summit provided a good foundation and set of resources to assist those interested in getting more involved in the Medicaid battles in their states. I encourage anyone concerned about Medicaid issues in their state or simply interested in getting more involved in advocating for complex rehab technology at the state level to go to ncart.us/medicaid. The list of arbitrary proposed state budget cuts impacting complex rehab is growing. Get involved in being a part of the solution today.

Clearly it is going to be another busy year, ripe with opportunities to further advance positive outcomes for the complex rehab industry. If the industry continues to build on the significant educational and lobbying efforts with policymakers, legislators, consumer and clinician groups, and other stakeholders over the past few years, I am confident 2011 will be a positive year for the complex rehab industry.

This article originally appeared in the March 2011 issue of Mobility Management.