RESNA rule worries rehab

WASHINGTON - With the Nov. 15 start date for the revamped power mobility benefit come and gone, the industry has begun to tackle its next big obstacle: Beginning next year, CMS will require that an independent ATP evaluate beneficiaries for certain PMDs. On April 1, 2008, the agency will also require that a supplier who employs an ATS provide the equipment. The requirements are part of CMS's new coverage criteria for PMDs. The industry has argued, ever since the agency released the new coverage criteria last summer, that there aren't enough RESNA-credentialed professionals to meet the requirements. "Providers are going to get stuck," said Dan Lipka, an ATS who works for Miller's Sales & Rentals in Akron, Ohio. "Customers are going to yell at us, 'I need a wheelchair!' and we'll have no way of documenting that by the appropriate professional." There are a "couple thousand" ATPs and ATSs nationwide, according to RESNA. That number increases up to 12% each year, but the organization expects a "significant jump" in applications in 2007--08, said Tom Gorski, executive director (See related story). But only a small portion of the current ATPs specialize in wheelchair evaluations, industry sources pointed out. Of those who do, some work with children (Medicaid) not adults (Medicare). Then there's this: ATPs who work for manufacturers or providers can't be involved. The coverage criteria states: "The ATP may not have any financial relationships with the supplier." Lipka ran some numbers for Ohio, and he found that in Cleveland--a city of some 2 million people--there are currently no ATPs that he's aware of who perform wheelchair evaluations for Medicare beneficiaries. "Others are reporting similar findings," he said. It's true that the industry needs to attract more therapists to the field, said Mark Schmeler, an OT and ATP who sits on the faculty of the University of Pittsburgh's Department of Rehabilitation Science & Technology. To do that, it should first work to debunk myths that therapists may have about conducting wheelchair evaluations. "We need to show therapists that it's a business opportunity," he said. "There's an impression out there that no one pays for evaluations, but if you code them properly, it's reasonable." But some in the industry believe that CMS should expand the requirement to include other credentials, such as NRRTS's RRTS and CRTS. Whatever its argument, Simon Margolis believes CMS will hear the industry out. "I think they're going to look at the number of ATPs at the end of 2007 and get a feeling for whether there are enough," said Margolis, an ATP and ATS who's vice president for clinical and professional development at National Seating & Mobility. "The medical directors have proven to be rationale. If there aren't enough ATPs, they know they'll have to do something about it, because there'll be an obvious access problem."