Everyone thinks this is a terrible idea—except Medicare


I’ve written twice now about CMS’s plan to set up some complex rehab codes as capped rental—and I still can’t quite believe it.

When I talked to Rita Hostak about it in July, she said Medicare planned to save $130 million, based on the fact that a lot of capped rentals get returned when the patient is done using them. However, Rita told me, that’s not how complex rehab works. 

Rita, with 170 stakeholders, told CMS about this as well. 

CMS seems to have ignored the fact that complex rehab is individually configured for people with long-term disabilities and gone ahead with its proposed rule, marking it a “final rule” at the end of last month

The reaction I’ve heard from providers and other stakeholders: complete disbelief.

“Now is the time for the agency to stop acting in a vacuum,” Alex Bennewith, vice president, government relations at United Spinal wrote to me this morning. “Consumers are saying enough is enough!”

Stakeholders are rallying the troops, contacting top people at CMS and reaching out to the gentlemen who sponsored H.R. 942 and S. 948 (bills that would create a separate benefit for complex rehab) to try to get this changed before the April implementation date. 

It seems pretty clear cut to me; the savings aren’t there, and trickling payments for expensive equipment over 13 months will put providers in a serious financial quandary, which is sure to affect access. 

“Consumers rely on access to customized equipment and related services to enable them to live the lives they choose, from going to work, attending school, making medical appointments, and being productive members of the society in which they live,” Bennewith wrote.

Time will tell if stakeholders can make that message clear to lawmakers, since it apparently fell on deaf ears at CMS.