Separate Benefit Bill for Complex Rehab Launched in House

Separate Benefit Bill for Complex Rehab Launched in House

H.R. 4378 would formally distinguish complex rehab technology and its provision from DME.

By Laurie WatanabeMay 02, 2012

It’s official: The bill to finally and formally define complex rehab technology (CRT) – and to establish a separate Medicare benefit category for it – has been introduced in the U.S. House of Representatives.

The bill – H.R. 4378 – was introduced April 16 by Rep. Joe Crowley (D-N.Y.), a member of the House Ways & Means committee. The bill is named “Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012.”

Don Clayback, executive director of NCART, called the bill’s introduction “a major milestone,” and added in a news statement, “With legislation now introduced, we will begin a much broader effort to secure additional sponsors and work to get the bill attached to a larger piece of legislation and passed. The Separate Benefit Category Steering Committee will continue to provide direction on the legislative activities and decisions as the bill moves ahead.”

The steering committee comprises the American Association for Homecare, the Clinician Task Force, NCART, NRRTS, RESNA and United Spinal Association. The bill’s introduction coincided with the complex rehab technology industry’s annual Continuing Education & Legislative Advocacy (CELA) event, during which industry members and consumers met with legislators and their staffers on Capitol Hill.

Among this year’s action points during CELA, Clayback said, was generating interest in a companion bill for the Senate.

A Definition, An Explanation, A Need

H.R. 4378 begins by defining CRT and the people who benefit from it.

The bill acknowledges that people “with disabilities and significant medical conditions…experience physical, functional and cognitive challenges every day.” Examples of those conditions are listed: cerebral palsy, muscular dystrophy, multiple sclerosis, spinal cord injury, ALS and spina bifida.

The bill also lists examples of CRT: “complex rehabilitation power wheelchairs, highly configurable manual wheelchairs, adaptive seating and positioning systems, and other specialized equipment, such as standing frames and gait trainers.” These kinds of products, the bill explains, “enable individuals to maximize their function and minimize the extent and costs of their medical care.”

Consumer access to CRT is being limited by “inadequate coding, coverage and payment policies,” which also stifle the development of new CRT products, the bill states.

“Current Medicare policies often fail to adequately address the needs of individuals with disabilities, to consider the range of services furnished by complex rehabilitation technology suppliers, and to recognize and account for the complexity and unique nature of the equipment itself,” H.R. 4378 says.

CRT Is Distinct from DME

The bill goes on to explain that limited access to CRT is largely being caused by CRT being defined, from a payment perspective, as durable medical equipment (DME).

“CRT items serve patients with serious medical conditions that require a broader range of services and specialized personnel than what is required for standard DME,” the bill says. “Customizable CRT items also require more resources in the areas (of) configuring, training and education to ensure appropriate use and to optimize results.

“The Medicare program should recognize the specialized nature of the CRT service delivery model, the required supporting processes and technology-related CRT services, the credentials and competencies needed by the providing suppliers and critical staff, and the related costs involved. A separate benefit category for CRT items would allow for unique coding, coverage, and payment rules and policies that address the unique needs of persons with disabilities and acknowledge the extensive service component.”

An Orthotics & Prosthetics Precedent

Creating a separate benefit category for a highly specialized category of medical equipment has precedent, the bill adds.

“Congress has created a separate and distinct benefit category for orthotics and prosthetics (custom braces and artificial limbs), which have their own medical policies, accreditation standards, and payment calculations,” H.R. 4378 notes.

And Congress and the Centers for Medicare & Medicaid Services have previously acknowledged the unique characteristics of CRT by removing some CRT items from Medicare’s ongoing competitive bidding program for DME.

The bill includes a list of HCPCS codes that would be officially recognized as CRT. The CRT designation would not apply to adaptive automotive equipment or orthotics and prosthetics.

Medical conditions that would typically require CRT use would be defined as “Congenital disorders, progressive or degenerative neuromuscular diseases, or injuries or trauma that result in significant physical or functional needs and capacities.”

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at (949) 265-1573 or lwatanabe@1105media.com.