Stakeholders take 'proactive' approach to CRT recognition

WASHINGTON - Ongoing efforts to get Medicaid programs across the country to recognize complex rehab technology got a boost last month when AAHomecare announced it had contracted with Bridge Public Affairs.

The association has retained the firm for six months to work regulatory and legislative channels in various states to protect CRT from Medicaid reimbursement cuts.

“We think this is an opportunity to get some wins on a state level and build on the wins we had in 2018,” said Tom Ryan, president and CEO of AAHomecare.

AAHomecare says it stopped or limited cuts mandated by the 21^st Century Cures Act in 29 states last year. A DME provision in the Cures Act required CMS to cap its contribution to Medicaid reimbursement at Medicare reimbursement on Jan. 1, 2018.

So far, seven states have recognized CRT, with Tennessee the most recent. Efforts are already underway to recognize CRT in a number of other states, including New York (see related story below).

“This is becoming a more prominent issue,” said Don Clayback, executive director of NRRTS. “States are under financial pressure due to budgets and the Cures Act, and MCOs are proliferating. There are more dynamics now in the state environment.”

While strategies will differ from state to state, retaining a public affairs firm is a strong signal that stakeholders are now taking a more organized approach to protecting CRT.

“What's exciting about this is it's more proactive vs. reactive,” said John Goetz, who will lead the efforts at Bridge Public Affairs and who used to be the director of government affairs for Permobil.
AAHomecare believes working to recognize CRT will also give them another foothold in states, as it continues to work more generally on warding off reimbursement cuts and holding MCOs more accountable.

“This could open the door to work with John's group on other issues, not specific to CRT,” Ryan said. “But because of John's expertise, CRT seemed like a good place to start.”

Case study: New York

ALBANY, N.Y. - Stakeholders in New York hope the third time will be the charm for a bill to recognize complex rehab technology.

Stakeholders first succeeded in getting a bill introduced back in 2015. A bill was then introduced and passed by both the New York State Assembly and Senate in 2016 and 2017, but Gov. Andrew Cuomo vetoed it both times.

Stakeholders regrouped in 2018 and plan to get another bill introduced in the State Assembly early this year.

“Gaining some level of commitment from the governor's office to not veto the bill will be critically important,” said Doug Westerdahl, president and CEO of Monroe Wheelchair in Rochester, N.Y., who has been a key point person on the efforts.

Westerdahl expects “some language changes” in 2019, but the last bill introduced in the State Assembly would have: protected access for complex needs patients to quality CRT; established and improve standards and safeguards relating to the provision of CRT; and provided quality support for complex needs patients to stay in the home or community setting, and prevent institutionalization and hospitalizations and other costly secondary complications.

The Center for Disability Rights, a nonprofit advocacy and service organization for people with disabilities that joined efforts to recognize CRT in 2017, met with the governor's office in 2018 to ask why Cuomo vetoed the bill twice, Westerdahl says.

“No resolution came from that meeting, and while follow-up attempts have been made none have been received from the governor's office,” he said.

Stakeholders have heard it could be anything from a miscommunication to opposition from a union.

“The answer to what the issue is differs depending on who you're talking to,” said Seth Johnson, vice president of government affairs for Pride Mobility Products.

So, for the moment, stakeholders are waiting for the state legislature to pass a budget, hopefully by April 1, and then they'll finalize and implement a strategy.