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.
