The Objective

Getting Behind H.R. 4378

The Complex Rehab Technology Separate Benefit Category Legislation

June 29, 2012

Get Congress To Pass Legislation To Create A Separate Benefit Category

For CRT Within Medicare…….

H.R. 4378“Ensuring Access to Quality

Complex Rehabilitation Technology Act of 2012”

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The Objective

Significant challenges threaten access to Complex Rehab Technology (CRT) products and services for individuals with disabilities

Changes are needed (coding, coverage, payment) to fully recognize the specialized nature of CRT and the medical and functional needs of the individuals who rely on it

The purpose of a Separate Benefit Category (SBC) is to improve and protect access to these important products and services

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Why SBC Is Needed

Medically necessary and individually configured:• Manual and Power wheelchair systems

• Adaptive seating and positioning systems

• Other specialized items (standers, gait trainers) Requires evaluation, configuring, fitting,

adjustment, training, or programming Provided through an interdisciplinary clinical and

technology team (physician, therapist, ATP)Designed to meet the individual's specific and

unique medical, physical, and functional needs

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What Is CRT

Work began in September 2009 (Steering Committee, Consultants, Work Groups)

Two years spent developing detailed proposal, informative position paper, other supportive information and tools

Broad stakeholder engagement and support (consumers, clinicians, suppliers, manufacturers)

To establish SBC requires legislation from Congress first; then regulatory work with CMS

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History of SBC Initiative

Products and Coding-• Segregate CRT products from standard DME• Recognize specialized nature of CRT

Coverage Policies-• Base eligibility on functional needs• Remove “in the home” restriction for CRT

Supplier Standards-• Increase level of qualifications to provide CRT• Require service and repair capabilities

Payment Methodology-• Exempt CRT from Competitive Bidding• Recognize non-product service costs

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Key SBC Changes

ITEM CoalitionUnited Spinal AssociationALS AssociationNational Council on Independent Living American Association of People with DisabilitiesParalyzed Veterans of America Christopher and Dana Reeve FoundationSpina Bifida AssociationAnd others …..

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Consumer Support

American Occupational Therapy AssociationAmerican Physical Therapy AssociationRESNAClinician Task ForceAmerican Academy for Cerebral Palsy and

Developmental MedicineAmerican Academy of Physical Medicine and

RehabilitationAmerican Congress of Rehabilitative Medicine And others …..

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Clinician Support

The “Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012”

Introduced April 2012 by Ways & Means Committee member Congressman Joe Crowley (D-NY)

Creates separate Medicare DMEPOS benefit category for CRT and improves access and safeguards

For member questions or to sign-on, contact Nicole Cohen at Congressman Crowley’s office at 202-225-3965 or nicole.cohen@mail.house.gov

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SBC Legislation – H.R. 4378

Key provisions of H.R. 4378 include:• Creates separate category for CRT within the

Medicare DMEPOS benefit (similar to O&P)• Recognizes specific HCPCS codes as CRT and

allows new CRT codes as needed• Eliminates the in-the-home restriction for CRT• Increases supplier standards regarding

credentialed staff and repair capabilities• Exempts CRT from competitive bidding

Summary of Bill, text of Bill, and other info available at www.ncart.us

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SBC Legislation (cont’d)

House “Medicare” Committees-• Ways & Means Committee• Energy & Commerce Committee

Senate “Medicare” Committees-• Finance Committee• HELP Committee (Health, Education, Labor,

Pension)

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Key Congressional Committees

Now that H.R. 4378 has been introduced:

1. In the House: we need additional co-sponsors, especially from key committees

2. In the Senate: we need a “companion bill” introduced in the Senate; then need co-sponsors

3. We will be working with the staff of the key committees to address questions/comments

4. We need the bill to be “officially scored” by the Congressional Budget Office (CBO) to identify cost

5. Ultimate goal is to get H.R. 4378 attached to larger Medicare-related legislation and passed

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Legislative Road Map

CRT is individually configured to people with complex disabilities

These products and services are different than standard DME

CRT is specialized...like Orthotics/Prosthetics (custom braces and artificial limbs)

Broad Medicare DME policies and codes do not address needs of people with disabilities

H.R. 4378 must be passed to provide needed distinction and solutions

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Message To Congress

Congress gave a partial exemption from Competitive Bidding in 2008…but that only was needed for one class of CRT

Congress exempted complex power wheelchairs from “capped rental” legislation in 2010

Recognition needs to be expanded through the establishment of a Separate Benefit Category for CRT

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Congress Has Recognized CRT Is Different

1. Rep. Joe Crowley (D-NY)- W&M2. Rep. Gregg Harper (R-MS)- E&C3. Rep. Maurice Hinchey (D-NY)4. Rep. James Langevin (D-RI)5. Rep. John Larson (D-CT)- W&M6. Rep. Richard Neal (D-MA)- W&M7. Rep. Devin Nunes (R-CA)- W&M8. Rep. Jared Polis (D-CO) 9. Rep. Bill Posey (R-FL)

10. Rep. Dutch Ruppersberger (D-MD)11. Rep. Linda Sánchez (D-CA)

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H.R. 4378 Sign-Ons at 5-21-12

Via phone- call the U.S. Capitol Switchboard at 202-224-3121 and ask for your member’s office. Once connected, explain you are calling on a Medicare issue and ask for the “Health Legislative Assistant”.

Via email- go to www.access2crt.org and use the “Contact Congress” link; personalize the e-mail template and send.

In person- call the local office and make an appointment.

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Contacting Congress

A Washington DC actuarial firm (Dobson & DaVanzo) was hired to estimate the cost

Congressional estimates are typically made based on a 10 year projection

The “cost” of the bill is estimated at $5 Million a year (or $50 Million over 10 years)

Does not include the impact of “savings” from improved access to CRT

We need the Congressional Budget Office (CBO) to do an “official” scoring

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“Cost” of Legislation

SBC Headquarters: www.access2crt.org “Sign-up for Updates” “Contacting Congress” “Sponsor Scorecard” “Advocacy Tools”:

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Dedicated SBC Website

- ITEM Coalition Letter- CRT Facts & Figures- SBC Proposal (detailed)- Other items

- CRT Video- Position Paper- H.R. 4378 Summary - H.R. 4378 Full Text

Site will be open on Wednesday May 30th

Entitled “Complex Rehab Technology - Essential for Health. Essential for Life.”

Presents CRT from the perspectives of:• Individuals who use and rely on it • Physicians who prescribe it• Advocates who protect access

Invest 10 minutes and get a great overview of CRT; a “must see” for any policy maker

Can be viewed at www.ncart.us or on DVD

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New CRT Video

Don Clayback, NCART, dclayback@ncart.us

Laura Cohen, PT, PhD, ATP, laura@rehabtechconsultants.com

Elizabeth Cole, MS PT, U.S. Rehab, elizabeth.cole@usrehab.com

Gary Gilberti, ATG Rehab, ggilberti@atgrehab.com

Walt Gorski, AA Homecare, waltg@aahomecare.org

Rita Hostak, Sunrise Medical, rita.hostak@sunmed.com

Alan Lynch, ATP, A.T. Mobility Services, alynch@ame-lv.com

Simon Margolis, NRRTS, smargolis@nrrts.org

Tim Pederson, ATP, MED Group, tpederson@medgroup.com

Paul Tobin, United Spinal Association, ptobin@unitedspinal.org

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The SBC Steering Committee

Remember your mission….

Get your representatives in Congress to:

1. Sign-on to H.R. 43782. Provide advice and additional help3. Pass it when it comes to a vote

Don ClaybackExecutive Director, NCART

716-839-9728 or dclayback@ncart.uswww.ncart.us

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Open Discussion