the objective
DESCRIPTION
Getting Behind H.R. 4378 The Complex Rehab Technology Separate Benefit Category Legislation June 29, 2012. The Objective. Get Congress To Pass Legislation To Create A Separate Benefit Category For CRT Within Medicare……. H.R. 4378 “Ensuring Access to Quality - PowerPoint PPT PresentationTRANSCRIPT
Getting Behind H.R. 4378
The Complex Rehab Technology Separate Benefit Category Legislation
June 29, 2012
Get Congress To Pass Legislation To Create A Separate Benefit Category
For CRT Within Medicare…….
H.R. 4378“Ensuring Access to Quality
Complex Rehabilitation Technology Act of 2012”
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The Objective
Significant challenges threaten access to Complex Rehab Technology (CRT) products and services for individuals with disabilities
Changes are needed (coding, coverage, payment) to fully recognize the specialized nature of CRT and the medical and functional needs of the individuals who rely on it
The purpose of a Separate Benefit Category (SBC) is to improve and protect access to these important products and services
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Why SBC Is Needed
Medically necessary and individually configured:• Manual and Power wheelchair systems
• Adaptive seating and positioning systems
• Other specialized items (standers, gait trainers) Requires evaluation, configuring, fitting,
adjustment, training, or programming Provided through an interdisciplinary clinical and
technology team (physician, therapist, ATP)Designed to meet the individual's specific and
unique medical, physical, and functional needs
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What Is CRT
Work began in September 2009 (Steering Committee, Consultants, Work Groups)
Two years spent developing detailed proposal, informative position paper, other supportive information and tools
Broad stakeholder engagement and support (consumers, clinicians, suppliers, manufacturers)
To establish SBC requires legislation from Congress first; then regulatory work with CMS
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History of SBC Initiative
Products and Coding-• Segregate CRT products from standard DME• Recognize specialized nature of CRT
Coverage Policies-• Base eligibility on functional needs• Remove “in the home” restriction for CRT
Supplier Standards-• Increase level of qualifications to provide CRT• Require service and repair capabilities
Payment Methodology-• Exempt CRT from Competitive Bidding• Recognize non-product service costs
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Key SBC Changes
ITEM CoalitionUnited Spinal AssociationALS AssociationNational Council on Independent Living American Association of People with DisabilitiesParalyzed Veterans of America Christopher and Dana Reeve FoundationSpina Bifida AssociationAnd others …..
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Consumer Support
American Occupational Therapy AssociationAmerican Physical Therapy AssociationRESNAClinician Task ForceAmerican Academy for Cerebral Palsy and
Developmental MedicineAmerican Academy of Physical Medicine and
RehabilitationAmerican Congress of Rehabilitative Medicine And others …..
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Clinician Support
The “Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012”
Introduced April 2012 by Ways & Means Committee member Congressman Joe Crowley (D-NY)
Creates separate Medicare DMEPOS benefit category for CRT and improves access and safeguards
For member questions or to sign-on, contact Nicole Cohen at Congressman Crowley’s office at 202-225-3965 or [email protected]
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SBC Legislation – H.R. 4378
Key provisions of H.R. 4378 include:• Creates separate category for CRT within the
Medicare DMEPOS benefit (similar to O&P)• Recognizes specific HCPCS codes as CRT and
allows new CRT codes as needed• Eliminates the in-the-home restriction for CRT• Increases supplier standards regarding
credentialed staff and repair capabilities• Exempts CRT from competitive bidding
Summary of Bill, text of Bill, and other info available at www.ncart.us
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SBC Legislation (cont’d)
House “Medicare” Committees-• Ways & Means Committee• Energy & Commerce Committee
Senate “Medicare” Committees-• Finance Committee• HELP Committee (Health, Education, Labor,
Pension)
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Key Congressional Committees
Now that H.R. 4378 has been introduced:
1. In the House: we need additional co-sponsors, especially from key committees
2. In the Senate: we need a “companion bill” introduced in the Senate; then need co-sponsors
3. We will be working with the staff of the key committees to address questions/comments
4. We need the bill to be “officially scored” by the Congressional Budget Office (CBO) to identify cost
5. Ultimate goal is to get H.R. 4378 attached to larger Medicare-related legislation and passed
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Legislative Road Map
CRT is individually configured to people with complex disabilities
These products and services are different than standard DME
CRT is specialized...like Orthotics/Prosthetics (custom braces and artificial limbs)
Broad Medicare DME policies and codes do not address needs of people with disabilities
H.R. 4378 must be passed to provide needed distinction and solutions
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Message To Congress
Congress gave a partial exemption from Competitive Bidding in 2008…but that only was needed for one class of CRT
Congress exempted complex power wheelchairs from “capped rental” legislation in 2010
Recognition needs to be expanded through the establishment of a Separate Benefit Category for CRT
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Congress Has Recognized CRT Is Different
1. Rep. Joe Crowley (D-NY)- W&M2. Rep. Gregg Harper (R-MS)- E&C3. Rep. Maurice Hinchey (D-NY)4. Rep. James Langevin (D-RI)5. Rep. John Larson (D-CT)- W&M6. Rep. Richard Neal (D-MA)- W&M7. Rep. Devin Nunes (R-CA)- W&M8. Rep. Jared Polis (D-CO) 9. Rep. Bill Posey (R-FL)
10. Rep. Dutch Ruppersberger (D-MD)11. Rep. Linda Sánchez (D-CA)
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H.R. 4378 Sign-Ons at 5-21-12
Via phone- call the U.S. Capitol Switchboard at 202-224-3121 and ask for your member’s office. Once connected, explain you are calling on a Medicare issue and ask for the “Health Legislative Assistant”.
Via email- go to www.access2crt.org and use the “Contact Congress” link; personalize the e-mail template and send.
In person- call the local office and make an appointment.
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Contacting Congress
A Washington DC actuarial firm (Dobson & DaVanzo) was hired to estimate the cost
Congressional estimates are typically made based on a 10 year projection
The “cost” of the bill is estimated at $5 Million a year (or $50 Million over 10 years)
Does not include the impact of “savings” from improved access to CRT
We need the Congressional Budget Office (CBO) to do an “official” scoring
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“Cost” of Legislation
SBC Headquarters: www.access2crt.org “Sign-up for Updates” “Contacting Congress” “Sponsor Scorecard” “Advocacy Tools”:
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Dedicated SBC Website
- ITEM Coalition Letter- CRT Facts & Figures- SBC Proposal (detailed)- Other items
- CRT Video- Position Paper- H.R. 4378 Summary - H.R. 4378 Full Text
Site will be open on Wednesday May 30th
Entitled “Complex Rehab Technology - Essential for Health. Essential for Life.”
Presents CRT from the perspectives of:• Individuals who use and rely on it • Physicians who prescribe it• Advocates who protect access
Invest 10 minutes and get a great overview of CRT; a “must see” for any policy maker
Can be viewed at www.ncart.us or on DVD
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New CRT Video
Don Clayback, NCART, [email protected]
Laura Cohen, PT, PhD, ATP, [email protected]
Elizabeth Cole, MS PT, U.S. Rehab, [email protected]
Gary Gilberti, ATG Rehab, [email protected]
Walt Gorski, AA Homecare, [email protected]
Rita Hostak, Sunrise Medical, [email protected]
Alan Lynch, ATP, A.T. Mobility Services, [email protected]
Simon Margolis, NRRTS, [email protected]
Tim Pederson, ATP, MED Group, [email protected]
Paul Tobin, United Spinal Association, [email protected]
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The SBC Steering Committee
Remember your mission….
Get your representatives in Congress to:
1. Sign-on to H.R. 43782. Provide advice and additional help3. Pass it when it comes to a vote
Don ClaybackExecutive Director, NCART
716-839-9728 or [email protected]
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Open Discussion