Conference Moves Rehab Sector Forward on Separate Benefit

ST. LOUIS — Complex rehab stakeholders who gathered in St. Louis last week to talk about a separate complex rehab benefit left the all-day consensus conference with three main take-aways: It needs to be done, there is much work yet to do and it is doable.

That was good news for the Complex Rehab Steering Committee, which hosted the conference and got the green light from some 50 attendees to go ahead with efforts to redefine the complex rehab Medicare benefit.

"I would say the biggest message was, 'You guys are on the right track.' We had consensus that this is something we need to do," said Don Clayback, executive director of the National Coalition for Assistive and Rehabilitation Technology Suppliers and a member of the steering committee.

The event offered stakeholders the opportunity to express their concerns and comment on the work of the steering committee and its work groups, which focused on such issues as fee schedule and coding, medical policy, claims processing and provider qualifications.

"We're trying to flesh out the details through the industry so that we can put those details together into a plan to create a redefined benefit for complex rehab," explained Tim Pederson, CEO of WestMed Rehab in Rapid City, S.D., and chair of the American Association for Homecare's Complex Rehab and Mobility Council.

He added, "I don't see us taking it out of the DMEPOS benefit." Instead, he and Clayback said, a reconfigured benefit might look a lot like the orthotics and prosthetics benefit that falls under DMEPOS.

"They are under the DMEPOS category, but they have their own coverage criteria," Clayback said.

One of the key issues of the day was the definition of complex rehab. "There is broad agreement on all the bullet points that define complex rehab; however, we have not been able to reach consensus in the industry on the wordsmithing of the definition," Pederson said. "There was some division on the steering committee on whether we should focus on the technology for the definition or [on] the process," he continued. "Is it the products or the process? What we determined is that it is both. We really can't define one without the other. So we are going back to the drawing board and try again."

Clayback said the definition would ultimately cover technology/products, users, the process and qualifications of people involved in the process.

Other discussion centered on how the industry can work with CMS and its contractors to change the regulatory arena and elevate the industry, Pederson said.