Deeper dive: New bill builds framework for separate benefit

BUFFALO, N.Y. - A new bill to create a separate benefit for complex rehab that's “less prescriptive” than previous bills will improve the chances of Congress passing it and CMS embracing it, stakeholders say.

“The general idea was to give CMS, in essence, direction, but to leave them some flexibility,” said Don Clayback, executive director of NRRTS. “Congress (works on the assumption) that CMS can take care of issues like these, with some direction.”

Reps. Jim Sensenbrenner, R-Wis., and Brian Higgins, D-N.Y., introduced the industry's latest attempt to create a separate benefit, H.R. 2408, on April 30. At press time, it had 14 co-sponsors.

A good example of where the bill is less prescriptive: One provision requires CMS to establish an additional designation for providing complex rehab—above and beyond the ATP—within a year and implement it within two years, but it allows the agency to work with stakeholders on specifics.

“We've been having some discussions around this, in general,” Clayback said, “but nothing has been decided on yet. So this language acts as a place holder.”

Stakeholders also dropped a few provisions from this version of the bill entirely, like a provision that addresses the replacement of items and a provision that addresses the ability to provide CRT to patients in skilled nursing facilities.

“We're saving those for phase 2,” Clayback said. “We need to get a separate benefit in place, then we can pick those things back up.”

Other provisions in the bill address CMS reviewing existing and new technologies on at least a yearly basis; the agency publishing an updated list of HCPCS codes that meet the definition of CRT on a yearly basis; and providers making available at least one qualified technician for service and repairs, and notifying patients in writing of those services.

“Providers should have that and they should have to inform consumers at the time of ordering,” Clayback said.

While the industry's No. 1 priority is passing a bill to stop competitive bidding pricing for accessories for complex rehab manual wheelchairs, stakeholders encourage providers not to lose sight of this bigger picture.

“If we had a separate benefit category, it could solve a lot of our issues,” said Weesie Walker, executive director of NRRTS. “So we're encouraging people to push both issues.”