Is It DME or Complex Rehab? Separate Benefit Proposal Shaping Up

BUFFALO, N.Y. — The project steering committee continues work on development of a separate Medicare benefit for complex rehab and, according to Don Clayback, committee chair, they're making progress.

"It's all about access to the products that fall under the complex rehab technology banner," Clayback said. "As providers know, as individual clinicians know and as consumers know, there are some barriers that prevent these products and services from being provided, and we're looking to address those."

The group began work on the concept last year, and since has held conference calls, Webinars, a panel discussion at Medtrade and in-person meetings in St. Louis and Nashville to gather input from stakeholders across the HME mobility sector.

"It's a very big project with a lot of details and nuances that need to be addressed," said Clayback, executive director of NCART, during a Jan. 22 update. Each of the three major components that will shape the separate benefit proposal — coding, coverage and payment — takes thought from every angle, including how any changes might impact the current system, "and we don't want to rush through," Clayback said.

The massive effort is paying off, he believes. Past identifying the big-picture objectives for a new rehab benefit — among them recognition of the services involved with providing complex rehab — the group is now working on fixes in five specific areas: fee schedule, coverage and conditions for payment, coding, claims processing and provider qualifications.

Details of the proposed changes will be finalized at a committee workgroup meeting Feb. 1 and 2 in St. Louis, and the results will be incorporated into a draft white paper to be released at the committee's next Webinar, scheduled for March 4.

Coding is a particular challenge "because CMS has had such a tendency over the last five years or so to bundle items," noted committee member Rita Hostak, vice president of government relations at Sunrise Medical. "The industry has suffered a lot financially by these groupings,"  she said, "so what we did as a coding workgroup was to take a step back and list everything that is potentially HCPCS-related to wheeled mobility and seating under a benefit category called complex rehab."