WASHINGTON--In an urgent race against time, the American Association for Homecare's Rehab and Assistive Technology Council is crafting a letter that implores HHS Secretary Michael Leavitt to exclude complex rehab from Medicare's competitive bidding project.

"We believe that the secretary has the authority to exempt Group 3 [complex rehab] from competitive bidding and plan to push that issue," said Tim Pederson of WestMed Rehab in Rapid City, S.D., new chair of the council.

Pederson said on Friday that the letter had not yet been finalized, but the RATC hopes to have it completed and sent sometime this week. That still gives the secretary time to act before CMS' bidding window closes on July 13, he said.

"All it takes is for the secretary to say so," Pederson said.

The letter will stress several reasons why complex rehab is not a good candidate for competitive bidding, which is set to be implemented in 10 cities next year and another 70 in 2009. Ten product categories, including rehab products, are included in the initial round.

"Our major point is that complex rehab should not be in the competitive bidding program. It's too individualized, it's too specialized, and frankly, the market is too small for significant savings to be demonstrated," Pederson said. "If we just look at the data from TriCenturion, that makes the case quite well. Less than 10 percent of power mobility in Jurisdictions A and B is Group 3 [complex rehab]. If less than 10 percent is Group 3, that indicates that complex rehab is not the root of the problem CMS is trying to solve."

Mandated by the Medicare Modernization Act, competitive bidding's goal is to gain "significant savings" in the purchase of home medical equipment. But RATC's position is that those savings have already been achieved in the sector, largely through last year's reimbursement reductions and coding changes.

"I think we have already achieved significant savings. Maybe CMS will see that when they get the first-round bids," said Pederson.

The letter comes as advocates for H.R. 2231--the Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007, introduced in May by Reps. Tom Allen, D-Maine, and Ron Lewis, R-Ky.--continue to push for its support on the Hill. The bill, which is backed by the National Coalition for Assistive and Rehab Technology, would carve rehab out of competitive bidding and "ensure that Medicare beneficiaries would continue to have access to appropriate complex rehab and assistive technology products," according to NCART.

"We fully support H.R. 2231," Pederson said. "[It] is an important legislative initiative. It would be very nice if that would pass and we would support that. But time is working against us. It's time to appeal directly to the secretary."

Pederson said he is convinced that officials at CMS understand the nature of complex rehab, but they have not communicated that knowledge to Leavitt. "They realize that it is quite a bit different from conventional home medical equipment and they understand what makes it different. But I don't think they have the urgency to share the differences with the secretary," Pederson said. "Being that no one else will do it, I think we must do it."

Meanwhile, Sen. Arlen Specter, R-Pa., has also written Leavitt championing a rehab carve-out. In a letter dated June 15, Specter wrote: "Due to the significant changes to the power wheelchair benefit that we worked closely on last year, which were implemented Nov. 15, 2006, and the resulting impact on beneficiary access, rehab power product categories should be removed from the initial phase of competitive bidding."

Specter also stated that "withdrawing standard and complex power wheelchairs from the initial phase of competitive bidding is in the best interest of America's seniors and disabled."

Seth Johnson, former RATC chair and vice president of government affairs for Pride Mobility Products, Exeter, Pa., said Pride has worked closely with Specter's office on mobility issues. "He is really a champion for the industry," Johnson said. "He understands the issues and is willing to get involved."

Johnson said he believes that the RATC letter and Specter's letter, combined with H.R. 2231, will help put a spotlight on the complex rehab issue. "Clearly, it is going to take a lot more [voices], but we need to continue to educate our legislators," he said.