NASHVILLE — Members of a steering committee pushing ahead on a Medicare complex rehab benefit found out early this week that the so-called "clawback" proposal, another issue on the rehab sector's agenda, is out.
The proposal had been devised to preserve the first-month purchase option on Group 2 and below power wheelchairs; elimination of the option is currently included in both House and Senate health reform plans. Under the proposal, "if for some reason the patient would die before 13 months had passed since they got the wheelchair, then the government in effect would 'claw back' however many months of rental that was worth," explained Tim Pederson, chair of AAHomecare's Complex Rehab and Mobility Council and a member of the steering committee.
But according to Pederson, the industry plan "did not survive the Congressional Budget Office score. It scored $200 million over 10 years, which is about $600 million short of what they believe they would get if they eliminated the first-month purchase option."
Now the sector is hoping to come up with another fix. "We are working with Sen. Arlen Specter's (D-Pa.) office on an alternative proposal," said Pederson, CEO of WestMed Rehab in Rapid City, S.D.
Regarding creation of a separate complex rehab benefit, the steering committee members looked at coding, coverage, payment and medical policy during a two-day meeting Dec. 8 and 9. Pederson said the group had convened to hammer out a firm approach this week before going to CMS and Congress, but decided that rushing it would ultimately be a disservice. "We must have broad-based buy-in from the entire industry or we are going to end up like the oxygen coalition," he said. "Fortunately, there is nothing that divides us."
So far, getting input from rehab stakeholders has been the key to avoiding strife as the committee looks to accomplish five key goals: 1) clearer and more consistent coverage policies; 2) tighter provider standards; 3) recognition of the depth and cost of product-related and clinical services required; 4) future payment stability; and 5) an improved model for Medicaid and other payers to follow.
As for the massive health care reform bills being debated in Congress, Pederson believes it is naive to think that the reform issues won't affect complex rehab efforts in some way, but determining those effects is difficult. "It is not going to change our ultimate goal, which is to achieve a broad-based definition of what is complex rehab," he said. "I think that goal is entirely consistent with health care reform."
As the long-term effort continues, Don Clayback, executive director of NCART and chairman of the committee, has stressed that the usual suspects can't be the only ones carrying the torch. Instead, seeking out consumer opinions will be a key part of the group's developing action plan. NCART's newly updated Web site includes information on creation of the new benefit as a knowledge base both for patients and professionals.
After the action plan is settled, committee members will ask for additional feedback from stakeholders via a series of conference calls and/or Webinars currently planned for January.
