UPDATE - Securing a Separate Benefit Category for Complex Rehab Technology

Don Clayback, Steering Committee Chair

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Overview

It’s been said that “good things come to those who wait”. However, when it comes to the Separate Benefit Category for Complex Rehab Technology (CRT), while we are looking for good things we won’t achieve them by waiting. The establishment of a Separate Benefit Category is needed to protect and improve access to CRT for individuals with disabilities and complex medical conditions.

With this is mind, work is continuing on a variety of fronts and we are making progress in accordance with our 2011 plan.

The process of securing a Separate Benefit Category involves two distinct, but related, pathways.

The first pathway is legislative. We need Congress to pass the legislation required to set up a separate category under Medicare’s DMEPOS benefit. The second pathway is regulatory. Once legislation is passed, we will be working with CMS on the implementation of the legislation and the development of related policies and other changes. The following update provides a review of recent activities and of what lies ahead.

 Major Clinician Groups’ Endorsements

As a result of our continued discussions and outreach to all CRT stakeholders, we are very happy to report the endorsements of two well respected clinician groups. The American Occupational

Therapy Association (AOTA) and the American Physical Therapy Association (APTA) have both signed on as supporters of our initiative. AOTA is a national association with over 40,000 members.

APTA has a national membership of over 77,000 members. The support of their national offices and their communication to their members across the country will be extremely helpful as we move ahead. Special thanks go out to the members of the Clinician Task Force for their work in carrying the CRT Separate Benefit Category message to their respective professional organizations.

 Proposed Legislation

Based on the work completed in 2010 and early 2011, we have started to engage Congress equipped with our legislative package consisting of a concise position paper, a detailed proposal providing background and specific changes, the written support of key consumer and clinician groups, and draft legislation that Members of Congress can use to establish a Separate Benefit Category. The CELA Conference in February provided us with a great initial opportunity to share our legislative package directly with Members of Congress in their Washington, DC offices. We are building on those meetings.

The draft legislative language has also been circulated to other stakeholder groups for analysis and comment. We continue to receive valuable feedback and suggestions from supporting organizations. At this point the draft language remains open for review and input.

 Legislative Scoring

An important question that potential Congressional supporters want answered is the estimated cost of the proposed legislation. Given the nature of the changes we seek, that answer requires a significant amount of data and calculations. Accordingly, we have engaged an independent economic research firm and they are in the process of completing their analysis. Their report will contain the financial “scoring” of the proposed legislation and will provide an estimate of the expected cost of the changes we are seeking. Their report will follow the model used by the Congressional Budget Office (CBO) and will provide the estimated projected cost over a 10 year period.

 Upon receiving the independent scoring report, we will resume our targeted discussions with Members of Congress that have been identified as potential champions for our issues. Our goal is to secure a Member of Congress from both the Democrat side and the Republican side to jointly introduce the Bill. This bipartisan introduction will set the stage for us to engage in broad grassroots efforts to secure additional co‐sponsors and push the Bill to passage.

 Ongoing Work Group Activities

In addition to the Steering Committee, there are other work groups that have been established to focus on specific areas of this initiative. These work groups are the Coverage Work Group, the

Coding Work Group, the Standards Work Group, and the Legislative Work Group. Each group continues to meet to complete their respective assignments.

Next Steps

Getting our Bill finalized and introduced is our priority. We’ll then move on to generate additional

Congressional support to get our legislation passed. To help better understand the process, here’s an outline of the steps that lie ahead:

1.) Obtain bipartisan commitment to introduce the needed legislation from two Members of Congress (one Democrat and one Republican). This is our immediate focus and will involve discussions on the details of our issues, the draft language, the related costs, and the potential offsets to allow the Bill to be budget‐neutral.

2.) Next, the draft legislation (with any desired modifications) will be sent to the Office of the

Legislative Counsel in Congress so that it can be reviewed, edited, and prepared for formal introduction.

3.) Once the legislative language is finalized, it will be formally introduced and assigned a Bill number. This is a critical achievement, because once we have a Bill introduced we can then most effectively engage all stakeholders in grassroots efforts focused on that specific Bill number to garner additional co‐sponsors.

4.) Upon introduction the Bill will be referred to a Committee of Jurisdiction. There it will be subject to additional review.

5.) At some point (before introduction or after introduction) the Bill will be forwarded to the Congressional Budget Office for their official scoring of the projected financial cost over a 10 year period.

6.) Finally, with enough Congressional support, our legislation will be attached to a larger Bill and be brought to the floor of the House and/or Senate for a vote. It needs to be passed in both chambers and then sent on to the President for signing. Once passed and signed we have accomplished our legislative objective and can move on to the implementation.

At the start of this year we stated our efforts in 2011 need to be viewed as a marathon, not a sprint.

So stay hydrated and pace yourselves. We continue to make progress in a deliberative manner and are well positioned to pursue the required activities that lie ahead. As an important CRT stakeholder, your current assignment is to remain informed and be ready to work with your Members of Congress when called upon. Thanks for your continued involvement and support!

 Questions and Comments

As a reminder, a variety of documents related to our Separate Benefit Category initiative can be downloaded from the NCART (www.ncart.us) or NRRTS (www.nrrts.org) websites.

 To share questions, comments, or suggestions regarding the Separate Benefit Category initiative please contact any of the project’s Steering Committee members:

• Don Clayback at NCART - dclayback@ncart.us;
• Laura Cohen, PT, PhD, ATP‐ Rehabilitation and Technology Consultants at laura@rehabtechconsultants.com;
• Elizabeth Cole, Director of Clinical Rehab Services‐ US Rehab at elizabeth.cole@usrehab.com;
• Gary Gilberti, President‐ Chesapeake Rehab Equipment at ggilberti@chesrehab.com;
• Walt Gorski, Vice President‐ American Association for Homecare at waltg@aahomecare.org;
• Rita Hostak, Vice President of Government Affairs‐ Sunrise Medical at rita.hostak@sunmed.com;
• Alan Lynch, ATP, Director of Seating & Mobility‐ Wright & Filippis at alan.l@wright‐filippis.com;
• Simon Margolis, Executive Director‐ NRRTS at smargolis@nrrts.org;
• Tim Pederson, ATP, Director‐ The MED Group at tpederson@medgroup.com; and
• Paul Tobin, Presiden t‐ United Spinal Association at ptobin@unitedspinal.org.

 Don Clayback serves as Chair of the Separate Benefit Category Steering Committee and is Executive Director of the National Coalition for Assistive and Rehab Technology (NCART). He can be reached at dclayback@ncart.us or 716‐839‐9728.