9.5 percent payback: Rehab industry seeks relief

Sunday, July 27, 2008

WASHINGTON - The rehab industry is chasing another carve-out, this one from a 9.5% nationwide cut for all products included in national competitive bidding.

Congress passed a bill July 15 that carves out complex rehab items from competitive bidding in the future, but as one of the 10 product categories included in Round 1 of the program, they're still in line for the cut.

"A parallel carve out from the cut would make sense," said Laura Cohen, a physical therapist and co-coordinator of The Clinician Task Force. "The cut will result in the same access problems as competitive bidding."

The bill delays competitive bidding in exchange for the cut. The cut goes into effect Jan. 1, 2009.

The industry is exploring two avenues for getting its second carve out. The first: Because the bill took effect retroactively on June 30 and competitive bidding didn't kick off until July 1, technically, complex rehab was never part of the program. As a result, industry stakeholders are talking with legislators about issuing a correction to the bill.

"We think there's some language that could be clarified," said Jerry Keiderling, vice president of The VGM Group's U.S. Rehab.

Industry stakeholders have also asked CMS to interpret the language of the bill.

The second (and more likely) avenue: Stakeholders are talking with legislators to attach a technical amendment to another bill that would carve out complex rehab from the cut.

"We think we have a good chance of getting this done," said Seth Johnson, vice president of government affairs for Pride Mobility Products.

The industry, however, has only "a small window of opportunity." Congress adjourns for the whole month of August, leaving September and a week or two in October. After that, sources say, members of Congress will return to their home districts to campaign for the Nov. 4 elections.

Some industry stakeholders believe they have their work cut out for them.

"The parallel carve out was an argument that we used on the Hill before the bill was passed, and it didn't fly," said Sharon Hildebrandt, executive director of NCART. "We're still trying, but it's going to be difficult."

Looking ahead, NCART plans to monitor the impact of the 9.5% cut on providers and beneficiaries. Disability groups like the ALS Association also plan to monitor the cuts.