The Objective

1. Getting Behind H.R. 4378 The Complex Rehab Technology Separate Benefit Category LegislationJune 29, 2012

2. The Objective Get Congress To Pass Legislation To Create A Separate Benefit Category For CRT Within Medicare……. H.R. 4378 “Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012”

3. Why SBC Is Needed • Significant challenges threaten access to Complex Rehab Technology (CRT) products and services for individuals with disabilities • Changes are needed (coding, coverage, payment) to fully recognize the specialized nature of CRT and the medical and functional needs of the individuals who rely on it • The purpose of a Separate Benefit Category (SBC) is to improveand protectaccess to these important products and services

4. What Is CRT • Medically necessary and individually configured: Manual and Power wheelchair systems Adaptive seating and positioning systems Other specialized items (standers, gait trainers) • Requires evaluation, configuring, fitting, adjustment, training, or programming • Provided through an interdisciplinary clinical and technology team (physician, therapist, ATP) • Designed to meet the individual's specific and unique medical, physical, and functional needs

5. History of SBC Initiative • Work began in September 2009 (Steering Committee, Consultants, Work Groups) • Two years spent developing detailed proposal, informative position paper, other supportive information and tools • Broad stakeholder engagement and support (consumers, clinicians, suppliers, manufacturers) • To establish SBC requires legislation from Congress first; then regulatory work with CMS

6. Key SBC Changes • Products and Coding- • Segregate CRT products from standard DME • Recognize specialized nature of CRT • Coverage Policies- • Base eligibility on functional needs • Remove “in the home” restriction for CRT • Supplier Standards- • Increase level of qualifications to provide CRT • Require service and repair capabilities • Payment Methodology- • Exempt CRT from Competitive Bidding • Recognize non-product service costs

7. Consumer Support • ITEM Coalition • United Spinal Association • ALS Association • National Council on Independent Living • American Association of People with Disabilities • Paralyzed Veterans of America • Christopher and Dana Reeve Foundation • Spina Bifida Association • And others …..

8. Clinician Support • American Occupational Therapy Association • American Physical Therapy Association • RESNA • Clinician Task Force • American Academy for Cerebral Palsy and Developmental Medicine • American Academy of Physical Medicine and Rehabilitation • American Congress of Rehabilitative Medicine • And others …..

9. SBC Legislation – H.R. 4378 • The “Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012” • Introduced April 2012 by Ways & Means Committee member Congressman Joe Crowley (D-NY) • Creates separate Medicare DMEPOS benefit category for CRT and improves access and safeguards • For member questions or to sign-on, contact Nicole Cohen at Congressman Crowley’s office at 202-225-3965 or nicole.cohen@mail.house.gov

10. SBC Legislation (cont’d) • Key provisions of H.R. 4378 include: • Creates separate category for CRT within the Medicare DMEPOS benefit (similar to O&P) • Recognizes specific HCPCS codes as CRT and allows new CRT codes as needed • Eliminates the in-the-home restriction for CRT • Increases supplier standards regarding credentialed staff and repair capabilities • Exempts CRT from competitive bidding • Summary of Bill, text of Bill, and other info available at www.ncart.us

11. Key Congressional Committees • House “Medicare” Committees- • Ways & Means Committee • Energy & Commerce Committee • Senate “Medicare” Committees- • Finance Committee • HELP Committee (Health, Education, Labor, Pension)

12. Legislative Road Map Now that H.R. 4378 has been introduced: • In the House: we need additional co-sponsors, especially from key committees • In the Senate: we need a “companion bill” introduced in the Senate; then need co-sponsors • We will be working with the staff of the key committees to address questions/comments • We need the bill to be “officially scored” by the Congressional Budget Office (CBO) to identify cost • Ultimate goal is to get H.R. 4378 attached to larger Medicare-related legislation and passed

13. Message To Congress • CRT is individually configured to people with complex disabilities • These products and services are different than standard DME • CRT is specialized...like Orthotics/Prosthetics (custom braces and artificial limbs) • Broad Medicare DME policies and codes do not address needs of people with disabilities • H.R. 4378 must be passed to provide needed distinction and solutions

14. Congress Has Recognized CRT Is Different • Congress gave a partial exemption from Competitive Bidding in 2008…but that only was needed for one class of CRT • Congress exempted complex power wheelchairs from “capped rental” legislation in 2010 • Recognition needs to be expanded through the establishment of a Separate Benefit Category for CRT

15. H.R. 4378 Sign-Ons at 5-21-12 • Rep. Joe Crowley (D-NY)- W&M • Rep. Gregg Harper (R-MS)- E&C • Rep. Maurice Hinchey (D-NY) • Rep. James Langevin (D-RI) • Rep. John Larson (D-CT)- W&M • Rep. Richard Neal (D-MA)- W&M • Rep. Devin Nunes (R-CA)- W&M • Rep. Jared Polis (D-CO) • Rep. Bill Posey (R-FL) • Rep. Dutch Ruppersberger (D-MD) • Rep. Linda Sánchez (D-CA)

16. Contacting Congress • Via phone- call the U.S. Capitol Switchboard at 202-224-3121 and ask for your member’s office. Once connected, explain you are calling on a Medicare issue and ask for the “Health Legislative Assistant”. • Via email- go to www.access2crt.org and use the “Contact Congress” link; personalize the e-mail template and send. • In person- call the local office and make an appointment.

17. “Cost” of Legislation • A Washington DC actuarial firm (Dobson & DaVanzo) was hired to estimate the cost • Congressional estimates are typically made based on a 10 year projection • The “cost” of the bill is estimated at $5 Million a year (or $50 Million over 10 years) • Does not include the impact of “savings” from improved access to CRT • We need the Congressional Budget Office (CBO) to do an “official” scoring

18. Dedicated SBC Website • SBC Headquarters: www.access2crt.org • “Sign-up for Updates” • “Contacting Congress” • “Sponsor Scorecard” • “Advocacy Tools”: Site will be open on Wednesday May 30th • - CRT Video • - Position Paper • - H.R. 4378 Summary • - H.R. 4378 Full Text • - ITEM Coalition Letter • - CRT Facts & Figures • - SBC Proposal (detailed) • - Other items

19. New CRT Video • Entitled “Complex Rehab Technology - Essential for Health. Essential for Life.” • Presents CRT from the perspectives of: • Individuals who use and rely on it • Physicians who prescribe it • Advocates who protect access • Invest 10 minutes and get a great overview of CRT; a “must see” for any policy maker • Can be viewed at www.ncart.us or on DVD

20. The SBC Steering Committee • Don Clayback, NCART, dclayback@ncart.us • Laura Cohen, PT, PhD, ATP, laura@rehabtechconsultants.com • Elizabeth Cole, MS PT, U.S. Rehab, elizabeth.cole@usrehab.com • Gary Gilberti, ATG Rehab, ggilberti@atgrehab.com • Walt Gorski, AA Homecare, waltg@aahomecare.org • Rita Hostak, Sunrise Medical, rita.hostak@sunmed.com • Alan Lynch, ATP, A.T. Mobility Services, alynch@ame-lv.com • Simon Margolis, NRRTS, smargolis@nrrts.org • Tim Pederson, ATP, MED Group, tpederson@medgroup.com • Paul Tobin, United Spinal Association, ptobin@unitedspinal.org

21. Open Discussion Remember your mission…. Get your representatives in Congress to: • Sign-on to H.R. 4378 • Provide advice and additional help • Pass it when it comes to a vote Don Clayback Executive Director, NCART 716-839-9728 or dclayback@ncart.us www.ncart.us