What's complex rehab?

Sunday, November 29, 2009

BUFFALO, N.Y. – During a Webinar yesterday, members of a steering committee discussed why they don’t plan to include certain Group 2 power wheelchairs in a separate benefit for complex rehab.

A listener to the Webinar asked members why they plan to focus solely on Group 3 power wheelchairs, especially since CMS categorizes certain Group 2 power wheelchairs as complex rehab.

“We do recognize there are issues around the Group 2 SPO and MPO (single- and multi-power option) codes,” said Rita Hostak, a member of the committee and vice president of government affairs for Sunrise Medical. “But when you try to carry that out to the next stage, there become some additional implications.”

One of those implications: If legislation to create a separate benefit for complex rehab includes certain Group 2 power wheelchairs, it could be a tougher sell, because the more wheelchairs that are included, the more it would cost Medicare.

Another: Including certain Group 2 power wheelchairs could defeat the purpose of creating a separate benefit in the first place.

“There’s a need for a clear definition of what’s complex rehab and what’s not,” said Tim Pederson, a member of the committee and CEO of WestMed Rehab. “It needs to be one or the other.”

But committee members don’t plan to let certain Group 2 power wheelchairs, as well as certain manual wheelchairs, fall by the wayside. They’re “seriously considering” recommending changes for certain codes like the K0004 custom manual wheelchair.

“We might recommend, for example, taking the technology that a lot of complex rehab providers use today, assigning it a new code and moving it to complex rehab,” Hostak said. “We’re just trying to find other options for solving and mitigating some of the problems without causing new ones down the road.”

Another question asked during the Webinar: Do members plan to develop a code-specific definition for complex rehab, even though that strategy caused problems when a separate benefit was created for orthotics and prosthetics. The short answer is yes.

“We need to have a broad definition that we can use to set the scope of what we’re looking to do, but we also need to have a more specific definition with HCPCS codes,” said Don Clayback, chairman of the committee and executive director of NCART.

The questions stemmed from a “working definition” of complex rehab that was distributed before the Webinar (go here for an abridged version: http://www.hmenews.com/blogwm/?p=432).

Members of the committee planned to have a definition finalized before a Dec. 8 meeting in Nashville to discuss their next steps, including determining regulatory and legislative needs and strategies, and gaining consumer and clinician support.