Category: Press Releases

First National Medicaid Summit Big Success

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Provided Excellent Forum For Medicaid Advocacy and Networking

Buffalo, New York – October 14, 2010 – The National Coalition for Assistive and Rehab Technology (NCART) held its first National Medicaid Summit in Nashville, Tennessee on October 6 and 7. Ninety‐five people from across the country came together to learn and network about protecting coverage and payment for Complex Rehab Technology (CRT) under state Medicaid programs.

This was a first‐time event held for CRT suppliers, manufacturers, state association directors, and other interested parties. The Summit was developed for this group around three objectives:

  • To increase knowledge of Medicaid’s structure and regulations along with the related beneficiary and supplier rights and responsibilities.
  • To provide information and tools for use in advocating on Medicaid matters and working with state agencies.
  • To improve state‐to‐state communication and networking regarding Medicaid CRT issues and advocacy.

Don Clayback, NCART Executive Director, stated “Medicaid is a significant payer for Complex Rehab Technology. Unfortunately given the financial challenges states are facing, there are increasing proposals and activities to reduce coverage and payment. With this in mind we felt the need to bring people together for a National Medicaid Summit.”

Speakers at the Summit consisted of legal experts and others with significant experience and expertise in Medicaid coverage of durable medical equipment and Complex Rehab Technology. These included Lewis Golinker, Esq., Assistive Technology Law Center; Carla Hogan, Esq., Tuczinski, Cavalier, Gilchrist & Collura; Jeff Baird, Esq., Brown & Fortunato; Marge Gustas, AT Advocacy Project, Neighborhood Legal Services; Rita Hostak, Vice President of Government Relations for Sunrise Medical; Doug Westerdahl, NCART Medicaid Committee Chair; Carol Napierski, Executive Director of the New York Medical Equipment Providers association; Karyn Estrella, Executive Director of the New England Medical Equipment Dealers association; Kam Yuricich, Executive Director of the Ohio Association of Medical Equipment Suppliers association; and Simon Margolis, Executive Director of the National Registry of Rehab Technology Suppliers. In addition representatives from CRT suppliers in other states shared their case studies.

Gary Gilberti, NCART President, said “While there are differences from state to state, there also is a great deal of commonality in terms of coverage and payment issues. That came out in the Summit. As CRT suppliers and manufacturers we play a role in advocating for our customers and need to be fully informed as to advocacy resources and strategies. Through education and collaboration we can better help protect access for our customers who have disabilities and need these products and services.”

The Summit consisted of 14 informative sessions developed to enable stakeholders to protect and improve Medicaid coverage and funding for CRT. These included “Medicaid Regulations & Advocacy”, “Supplier Responsibilities and Rights”, “Medicaid & Managed Care”, “State of the States Report”, “Developing Your State Relationship”, and “Medicaid Case Studies”. Moving ahead, attendees were encouraged to take advantage of the resources available in the Medicaid area of NCART’s website at www.ncart.us NCART has created a dedicated area to provide educational tools, case studies, a Medicaid News section, and a Medicaid Discussion Forum. All designed to assist in advocating for the appropriate coverage and payment of CRT.

NCART’s Medicaid Committee was pleased with attendee comments and evaluations. The post‐meeting evaluations indicated a very high level of benefit from attendance. Comments included:

  • “The quality of information was of most value. The quality of the attendees was excellent as well as the networking opportunities.”
  • “All of the information presented is very valuable. I will be able to refer back to the information for guidance and direction for future issues.”
  • “Great resources to take back to the real world.”


Doug Westerdahl, Medicaid Committee Chair, commented “We were very pleased with the attendance and feedback from this first‐ever conference. There was some great information shared and people went back home with new ideas and tools. Based on the attendee requests we are planning on making this an annual event. We’ll build on this and continue to serve as a resource for protecting and improving coverage for Complex Rehab Technology.” 

Release Date: 14-Oct-2010

Updated Proposal To Create Separate Benefit Category For Complex Rehab Technology

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Contains New Information and Will Be Used To Support Needed Congressional Legislation
 
Buffalo, New York – February 7, 2011 – The Separate Benefit Category Steering Committee has released an update to the “Proposal To Create A Separate Benefit Category For Complex Rehab Technology”. The January 2011 Proposal incorporates changes made since the issuance of the initial September 2010 Proposal and includes additional supporting exhibits. It provides the background, needed changes, and activities undertaken relating to obtaining a Separate Benefit Category under the Medicare program and will be distributed to members of Congress to support the introduction of needed legislation. 

The Separate Benefit Category Steering Committee consists of representatives from six national organizations: the National Coalition for Assistive and Rehab Technology (NCART), the American Association for Homecare (AAHomecare); the National Registry of Rehab Technology Suppliers (NRRTS), the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), the Clinician Task Force (CTF), and the United Spinal Association (United Spinal). 

The Separate Benefit Category initiative has received the endorsement of the ITEM Coalition, a broad based consumer-led coalition of over seventy distinct organizations (www.itemcoalition.org). Its membership includes a diverse set of disability organizations, aging organizations, other consumer groups, and voluntary health associations. ITEM’s focus is to build support for broad-based legislative and regulatory changes to address the problems of inadequate access to assistive devices, technologies and related services for people with disabilities and chronic conditions of all ages.

The initiative is in response to the significant challenges that threaten access to Complex Rehab Technology products and the supporting services used by individuals with significant disabilities and medical conditions. These individuals deal with physical, functional and cognitive challenges every day and utilize CRT to maximize their function and minimize the extent and costs of their medical care. Threats to these products and services stem from coding, coverage, and payment problems. These challenges have increased over the past several years and, without meaningful change to these policies, will only become greater in the future.

Complex Rehab Technology products and associated services include medically necessary, individually configured devices that require evaluation, configuration, fitting, adjustment or programming. These products and services are designed to meet the specific and unique medical, physical, and functional needs of an individual with a primary diagnosis resulting from a congenital disorder, progressive or degenerative neuromuscular disease, or from certain types of injury or trauma. CRT includes individually configured manual wheelchair systems, power wheelchair systems, adaptive seating systems, alternative positioning systems and other mobility devices.

The January 2011 “Proposal To Create A Separate Benefit Category For Complex Rehab Technology” can be found and downloaded at the NCART website at www.ncart.us under the Current Issues section. 

Release Date: 07-Feb-2011

“Discussion Paper” Released Regarding Separate Benefit For Complex Rehab Technology

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Download the Separate Benefit Discussion Paper

For Immediate Release
Contact – Don Clayback, Executive Director, 716‐839‐9728 or dclayback@ncart.us

Buffalo, New York – March 4, 2010 – Today the Separate Benefit Steering Committee released a Discussion Paper entitled “A Starting Point for Obtaining a Separate Benefit for Complex Rehab Technology”. This Discussion Paper is designed to allow individuals and organizations within the Complex Rehab Technology industry and profession, along with other interested parties, to engage in more detailed discussions regarding the pursuit of a Separate Benefit under the Medicare program, the related elements of implementation, and its potential impact on stakeholders.

Gary Gilberti, NCART President, said “This is a significant first step in creating greater awareness and dialogue around securing a Separate Benefit for Complex Rehab Technology. The Separate Benefit is a major undertaking, but something major is needed to protect the availability of these products and services to people that use them every day of their lives. With this document we can now have the necessary stakeholder discussions with other individuals and groups to develop the plans and actions required”.

The Separate Benefit initiative is in response to the significant challenges that threaten access to Complex Rehab Technology products and the supporting services used by individuals with significant disabilities and medical conditions. These individuals deal with physical, functional and cognitive challenges every day and utilize Complex Rehab Technology to maximize their function and minimize the extent and costs of their medical care. Threats to these products and services stem from coding, coverage, and payment problems. These challenges have increased over the past several years and, without meaningful change to these policies, will only become greater in the future.

Don Clayback, NCART Executive Director, stated “This Discussion Paper is the culmination of several months of focused efforts from a twenty person Work Group. But it is only the beginning. It provides an excellent initial outline of the changes needed that can now be shared for comment. We look forward to broader conversations and involvement from the consumer community, the clinician community, suppliers, and manufacturers regarding what additional fixes and changes are needed.”

The Separate Benefit Steering Committee currently consists of representatives from five organizations: the National Coalition for Assistive and Rehab Technology (NCART), the American Association for Homecare (AAHomecare); the National Registry of Rehab Technology Suppliers (NRRTS), the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), and the Clinician Task Force (CTF). Additional positions on the Steering Committee will be filled by representatives from the consumer and clinician community.

The Discussion Paper can be found at the NCART website at www.ncart.us under the Current Issues section. 

Release Date: 04-Mar-2010

OIG Power Wheelchair Report Underscores Complexity And Problems With Implementation Of New Regulations

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Buffalo, New York – January 8, 2010 – Last week the Health and Human Services’ Office of Inspector
General (OIG) issued a report entitled “Medicare Power Wheelchair Claims Frequently Did Not Meet
Documentation Requirements”. The report was based on a review of power wheelchair claims for the
first six months of 2007 and indicated a significant percentage of claims lacked certain components of
newly expanded documentation requirements.

The study covered the initial period of the single largest policy overhaul in the history of Medicare’s
coverage of power mobility. There were dramatic coding, coverage, and payment changes for these
devices including significant changes to the documentation requirements. Unfortunately, this initial
period was fraught with a lack of information on what exactly was required on the part of providers,
physicians, and CMS contractors. Given these factors, the findings are not a surprise.

Don Clayback, NCART Executive Director, stated “The report should not be interpreted as evidence of
fraudulent claims. Rather, the OIG report provides a clear indication of the widespread confusion and
uncertainty that existed with providers and physicians during the implementation of the new
requirements. There were major revisions to the level and type of documentation required for power
wheelchair claims and these revisions were implemented with minimal provider and physician
education.”

Reputable power mobility companies are accredited and have invested in the training and credentialing
of their staff to provide quality equipment and professional services to Medicare beneficiaries in their
communities. These companies are committed to doing what is required. The problem is the lack of
clarity and inconsistency on what documentation is needed.

Gary Gilberti, NCART President, said “Complex power wheelchair providers have been very supportive of
a system that includes documentation of an appropriate clinical evaluation, technology assessment,
home assessment and of medical necessity for the equipment. However the physician and provider
education regarding implementation of the new regulations in late 2006 lacked the level of detail and
specificity required for such major changes. In addition, some of the information required and the
reporting format is not in line with the typical protocols of prescribing physicians.”

Documentation requirements for power wheelchair claims are very complex and can include up to 6
distinct documents which can translate to 10 to 15 pages of paperwork. The level of specificity and
volume of information required in order for the documentation to be deemed adequate is greater for
power wheelchairs than any other Durable Medical Equipment covered by Medicare. Accordingly, full
compliance is extremely difficult and subject to misinterpretation without clear policies and consistent
documentation standards that are fully understood by all parties.

While the report indicates that for some claims documentation was not complete, given the diagnoses
and the medical needs of those individuals with severe disabilities that does not mean the equipment
was not medically necessary and properly prescribed by the beneficiary’s physician.

Clayback continued, “We could not agree more with the OIG’s recommendation that additional
education is needed. As an industry we have spent the last three years working to clarify the
requirements to secure better guidance and obtain better educational materials, particularly for the
medical community. We’re also glad to hear that CMS will be issuing new information and holding open
door forums to provide more detailed guidance and education for both physicians and providers. We’re
committed to working with CMS and its contractors to ensure Medicare beneficiaries with disabilities
get the equipment and services they need and providers comply with appropriate Medicare
regulations.”

Release Date: 08-Jan-2010

NCART Unveils New Website

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November 12, 2009 – For Immediate Release

Contact – Don Clayback, Executive Director, 716-839-9728 or dclayback@ncart.us

NCART Unveils New Website
Information and Resources to Protect Access to Complex Rehab Technology

Buffalo, New York – November 12, 2009 –  Today the National Coalition for Assistive and Rehab Technology announced the opening of their redesigned website at www.ncart.us  The website has been completely reorganized and updated to provide timely information and resources on Complex Rehab Technology products and services and help battle the issues that threaten consumer access.

Don Clayback, NCART Executive Director, said “With the coverage and funding issues now and those that lie ahead, our website will serve as an important tool in telling the Complex Rehab Technology story and protecting access to these important products and services.  It has been designed to provide information and resources in an easy-to-access format, to allow for increased advocacy interaction and communication, and to give us a structure that we can add to and enhance as we move ahead.”

The new website is organized under the following areas:

  • Current Issues- highlights significant issues that are currently in play that impact access to Complex Rehab Technology products and services.
  • Advocacy- describes NCART’s focus on protecting and promoting access to Complex Rehab Technology products and services and identifies NCART’s leadership with contact information.
  • Position Papers- presents NCART’s positions on important legislative and regulatory matters along with related background information and actions needed.
  • Medicaid- identifies resources for working with State Medicaid programs including Medicaid Strategic Assistance, Medicaid Discussion ForumMedicaid News, Medicaid Tools, and Medicaid Links.
  • Educational Material- provides documents, presentations, and studies to help educate stakeholders and policy makers regarding Complex Rehab Technology products, processes, and benefits.
  • Policy Makers- provides an overview of Complex Rehab Technology and offers direct assistance to policy makers on issues relating to the coverage and funding of the products and services involved.
  • Membership- provides a searchable list of NCART members by state along with the ability for interested companies to submit a membership application on-line.
  • Other Resources- provides searchable links to important organizations and websites along with links to videos relating to Complex Rehab Technology.
  • Updates- allows website visitors to register to receive periodic updates on important issues and events relating to Complex Rehab Technology.
  • Contact Your Legislator- allows website visitors to obtain the names of their federal and state legislative representatives and then communicate to them their positions on key issues.

Gary Gilberti, NCART President, stated “We are pleased to have created another tool that will allow all stakeholders….providers, manufacturers, consumers, clinicians, and policy makers….to be better informed regarding Complex Rehab Technology matters.  Upgrading the website has been one of our biggest priorities in making NCART a relevant resource in terms of advocacy and addressing industry issues.  An informative and easy to navigate website will be very helpful as we increase our efforts moving into 2010 and beyond.”

Release Date: 12-Nov-2009

NCART Secures Congressional Letter Supporting 9.5% Restoration

A Congressional letter initiated by Representative Tammy Baldwin (D-WI) requesting restoration of the 9.5% Medicare cut to Complex Rehab Power Wheelchairs was sent to House Leadership on October 19, 2009.

The letter was signed by 15 members of the House and provides the basis for the restoration of the cut and asks that the restoration be included as part of the developing health care legislation. The following Members signed the letter stating their support:

  1. Tammy Baldwin (D-WI)
  2. Zach Wamp (R-TN)
  3. John Tanner (D-TN)
  4. Steve Cohen (D-TN)
  5. Betty Sutton (D-OH)
  6. Tim Ryan (D-OH)
  7. James Langevin (D-RI)
  8. Patrick Kennedy (D-RI)
  1. Mary Bono Mack (R-CA)
  2. Judy Biggert (R-IL)
  3. Danny Davis (D-IL)
  4. Mark Souder (R-IN)
  5. Russ Carnahan (D-MO)
  6. David Wu (D-OR)
  7. Peter DeFazio (D-OR)

NCART thanks these Members of Congress for their support and will be using this letter to pursue additional Congressional support and resolution. A copy of the signed letter is available here.

Release Date: 19-Oct-2009

OIG Report On Power Wheelchairs Leaves Out Much Of The Story

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September 3, 2009 – For Immediate Release
Contact – Don Clayback, Executive Director, 716‐839‐9728 or dclayback@ncart.us

Washington, DC – September 3, 2009 – Yesterday the Health and Human Services’ Office of Inspector General (OIG) issued a report entitled “Power Wheelchairs in the Medicare Program: Supplier Acquisition Costs and Services” that included, in part, Complex Rehab power wheelchairs but substantially left out the services involved in providing these specialized products and the related costs incurred. The critical services and the required systems and infrastructure that are required for Complex Rehab power wheelchairs must be fully recognized when examining a category that is limited to the 7% of power wheelchair users with the most complex disabilities and functional needs.

Gary Gilberti, NCART President, stated “We are encouraged that the OIG somewhat recognized the service component in the provision of “Complex Rehab” power wheelchairs. However we are very concerned that they did not report the full range of services and the significant non‐product costs that are incurred over and above the acquisition of the product. This only serves to exacerbate the lack of recognition of the services and support that are critical for the successful provision of these products. The report presents an incomplete picture.”

The business model for a Complex Rehab provider is vastly different from that of a standard power wheelchair provider. The service and operating costs involved with Complex Rehab products are significant. A 2008 industry study indicated on average a company’s non‐product costs were almost equal to the acquisition costs of the products. These non‐product costs were expended in the following areas: intake, qualification, and documentation (14%); evaluation, specification, and fitting (23%); purchasing, receiving, assembly and delivery (13%); billing and collection (12%); service and repair (11%); sales and marketing (10%); regulatory and compliance (4%); and administration and support (13%). In light of all these costs Complex Rehab companies reported business profits averaging less than 5%. This reported profit level was for 2007 and does not reflect the impact of the 9.5% reimbursement cut in 2009.

Reimbursement levels for Complex Rehab products and services have been significantly reduced over the past three years. In 2006 the fee schedules for power wheelchairs and accessories were cut. Additional cuts were made in 2009 as this equipment, along with seating systems, repair parts, and other items, were reduced another 9.5%. As a consequence, the availability of the necessary technology and services has suffered. Due to numerous cuts in reimbursement to Complex Rehab suppliers, a number of companies in this segment of the business have exited the industry. This leaves Medicare recipients and others in the precarious position of losing access to qualified suppliers.

Gilberti continued “This report illustrates one of the biggest challenges involved in protecting continued access to complex rehab products and services for people with disabilities. That is this lack of understanding and recognition for the service component. These products are not ordered out of a catalog and dropped on someone’s doorstep. In addition, they require significant after‐the‐sale service and support.”

Don Clayback, NCART Executive Director, stated “We need to gain support for the Complex Rehab message. There is a small group of people in our country that have significant disabilities and deal with physical, functional, and cognitive challenges every day. They, and their medical teams, use assistive technology and rehab equipment to maximize their function and minimize the extent and costs of their medical care. Funding cuts are taking away access to the complex rehab products and services they rely on. This OIG report is another hole in the Complex Rehab boat. We will be following up with the OIG and CMS to provide additional information so an accurate and full picture can be presented.”

Release Date: 03-Sep-2009

NCART Releases Video Highlighting Access Problems For People With Disabilities

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July 17, 2009 – For Immediate Release
Contact – Don Clayback, Executive Director
716-839-9728 or dclayback@ncart.us

Washington, DC – July 17, 2009 – The National Coalition for Assistive and Rehab Technology (NCART) has released an educational video entitled “All’s NOT Well in Wellsville”. This video illustrates the type of access problems that are occurring across the country for people with disabilities that require complex rehab equipment such as specialized power wheelchairs, custom positioning systems, and other adaptive equipment.

Reimbursement levels for Complex Rehab products and services have been significantly reduced over the past three years. In 2006 power wheelchairs and accessories were reduced by 27%. Then in 2009 this equipment, along with seating systems, repair parts, and other items were reduced an additional 9.5%. As a consequence, the availability of the necessary technology and the services has suffered.

Gary Gilberti, NCART President, stated “There is a small group of people in the US that have significant disabilities and deal with physical, functional, and cognitive challenges every day. They, and their medical teams, use assistive technology and rehab equipment to maximize their function and minimize the extent and costs of their medical care. But there is a crisis upon them. Funding cuts are taking away access to the complex rehab products and services they rely on.”

The “All’s NOT Well In Wellsville” video will be used to educate policy makers regarding access problems that are negatively impacting people with disabilities, their family members, and the medical professionals that care for them. The video provides a real-life view of individuals that rely on this equipment and the supporting services that are required. It also depicts the challenges they and their medical professionals are facing.

Don Clayback, NCART Executive Director, stated “This video gives a snapshot of what is happening across the country. Action needs to be taken to stop this growing negative trend. The first action must be focused on educating Congress and getting them to help. A great opportunity for relief is the 2009 healthcare reform legislation, where Congress can include a provision to restore the 9.5% cut to complex rehab products and related accessories that was put in place on January 1, 2009.”

The 15 minute video can be viewed at http://www.ncart‐wellsville.com. Copies of the video and related talking points can be obtained by contacting NCART at dclayback@ncart.us.

Release Date: 17-Jul-2009

NCART Names New Executive Director

For Immediate Release
Contact: Gary Gilberti, President; 800-777-6981 Ext. 201; ggilberti@chesrehab.com

Washington, DC — June 15, 2009 — The National Coalition for Assistive and Rehab Technology (NCART) has announced that Donald E. Clayback will be assuming the Executive Director position of the organization effective July 15, 2009.

Gary Gilberti, President of NCART and CEO of Chesapeake Rehab Equipment, stated “NCART looks forward to benefiting from the leadership and experience Don brings to our organization. He is a well respected industry leader and advocate who has been an active Board member since the formation of NCART. He can now devote his full time efforts to our issues.”

Gilberti added “We thank Sharon Hildebrandt, our outgoing Executive Director, for her contributions to NCART during her tenure. She helped establish the identity of complex rehab in Washington and worked hard to get our issues recognized.”

Given the challenges facing the complex rehab providers and manufacturers, NCART is increasing its resources in order to provide greater representation and assistance to the industry.

“I’m very excited about joining NCART and leading the group’s efforts to protect access to complex rehab products and services. Rehab providers face significant challenges and NCART can play a critical role in representing their interests and those of the individuals with disabilities that they serve” said Clayback.

Clayback has over 22 years of experience in the home medical equipment and rehab industry as a provider, consultant, and advocate. He most recently held the position of Vice President of Government Relations for The MED Group, a national association of home medical and rehab equipment providers. He has been actively involved in industry issues on a national level and is a frequent speaker at national and regional conferences. Prior to joining MED, Clayback served as an industry consultant and held the position of Vice President at two HME/Rehab companies. His pre-industry career was as a CPA with the accounting firm of Price Waterhouse.

Bill Elliott, President and CEO of The MED Group, stated “MED is committed to the betterment of the complex rehab industry. We are happy to see the strengthening of NCART as it focuses on the multiple issues facing the industry on federal and state levels.”

Release Date: 15-Jun-2009