Group moves to exempt rehab from NCB plan

Monday, May 31, 2004

WASHINGTON - The National Coalition for Assistive Rehab Technology has endorsed exempting rehab products from the competitive bidding provision of the Medicare Modernization Act.

The coalition asked for the exemption of high-end rehab based on the products’ “therapeutic advantage” and the specialized service they require.

“If we were going to survive in an environment where competitive bidding was going to be a reality, we were going to have to make the case that for heavily service oriented businesses, like rehab, competitive bidding seems very inappropriate,’” said NCART board member Simon Margolis.

The MMA allows products to be exempt from competitive bidding if they are “not likely to result in significant savings” or if they “have a greater therapeutic advantage to individuals.”

NCART suggests in its competitive bidding regulatory position paper that the HHS secretary create a work group of physicians, manufacturers and providers to consider a rehab exemption and define the therapeutic benefit of different rehab items. It also promotes the creation of professional standards and a definition of what constitutes high-end rehab.

“If you read the tea leaves, the chance of defeating competitive bidding outright is very low,” said Margolis on NCART’s decision to part with the philosophy of AAHomecare, which is lobbying for an across-the-board recall of competitive bidding for all DME.

“One of the difficulties we faced in RATC was the more global, eclectic nature of AAHomecare,” he said. “Because of that, we were constrained by AAHomecare leadership from truly expressing this opinion. They wanted to present the opinion for all its members that they wanted to defeat NCB entirely.”

NCART in February broke from AAHomecare and RATC to form a coalition focused on the needs of rehab providers.

Recent information from CMS indicates an opposition to a carve-out. A press release in April on changes in K0011 policy says that the administration expects to include power mobility in the competitive bidding program, set to begin in 2007. NCART plans, however, in the next few years an aggressive campaign that would distinguish itself and the rehab industry on Capitol Hill.

“The discussion on NCB is going to go on and on, and I think in the long run we will win a carve-out for rehab. “ said Margolis. “Rehab is getting defined, and NCART already is getting some play. We are moving forward.”