Getting the Right Mobility Equipment & Services for PeopleEquipment & Services for People
with Disabilities March 28 2013March 28, 2013
Alexandra Bennewith, MPAVice President Government Relations United Spinal AssociationVice President, Government Relations, United Spinal Association
Thank You To Our SponsorsThank You To Our Sponsors
Who is United Spinal Association?
Roll on Capitol Hill, p ,June 16‐19, 2013
United Spinal Association’s Annual Legislative and Advocacy Conference
• United Spinal’s Public Policy department
• NSCIA – United Spinal’s Membership and Chapter division
• Users First – United Spinal’s grassroots advocates division
You can find more information at:http://www.unitedspinal.org/events/roll‐on‐capitol‐hill/ttp // u tedsp a o g/e e ts/ o o cap to /
Upcoming WebinarsUpcoming Webinars• May 23 ‐ Ensuring Quality Services and Supports under
MedicaidMedicaidClarke Ross, American Association on Health and Disability
J 6 Ad 101 R ll C it l Hill• June 6 ‐ Advocacy 101, Roll on Capitol Hill Alexandra Bennewith, United Spinal AssociationAnn Eubank, Users First
• July 25 ‐ 23rd Anniversary of the ADAJames Weisman, United Spinal Association
http://www.spinalcord.org/webinar‐archive/
QUESTIONS?
To ask me a question or make a commentTo ask me a question or make a comment, please type it in the “Questions” box
[email protected](202) 556‐2076, x.7102
What’s going on in WashingtonBoth the Republican and Democrat Budgets passed last week • President’s Budget ‐ April 10 (much later than usual)
Sequester and government funding• $85 billion in cuts (sequester) went into effect March 1• Government funding was set to end March 27 g• Just last week, Congress approved continued government funding
through September 30. • $16 trillion debt ceiling limit – July/August• $16 trillion debt ceiling limit – July/August
Physician payment cuts under Medicare • Congressional committees thinking about permanent fixCongressional committees thinking about permanent fix
Health Reform• Affordable Care Act is 3 years old this monthAffordable Care Act is 3 years old this month
What does this mean for us?
• We/you must be part of the dialogueo Make your voices heard
• Congressional offices have to hear from us/you• Congressional offices have to hear from us/youo Tell Congressional offices our/your stories
• If they don’t hear from us/you, they don’t know what our/your concerns areo May lead to additional cuts to the equipment ando May lead to additional cuts to the equipment and
services you need
Federal Spending on Medicare, Medicaid and Social Security 2010Medicaid and Social Security, 2010
Medicare Population
Medicare Benefit Payments by Type of Service, 2011
What is Complex Rehab Technology?What is Complex Rehab Technology?
Products and services, including medically , g ynecessary individually configured manual and power wheelchair systems, adaptive seating systems, alternative positioning systems, and other mobilityalternative positioning systems, and other mobility devices that require evaluation, fitting, design, adjustment and programming.
Such technology is designed to meet the specific and unique medical and functional needs of an individual with primary diagnoses resulting from aindividual with primary diagnoses resulting from a congenital disorder, progressive or degenerative neuromuscular disease, or from an injury or trauma.
Complex Rehab Technology d fMedicare Separate Benefit
Medicare currently does not have unique coverage for the more complex needs of individuals with disabilities and chronic medical conditions requiring customized q gproducts and services that are medically necessary.
In the interest of quality healthcare and optimalIn the interest of quality healthcare and optimal functionality for individuals with disabilities and chronic medical conditions, a separate Medicare benefit category must be establishedcategory must be established.
More About Complex Rehab TechnologyMore About Complex Rehab Technology
• Complex rehab technology is unique and differsComplex rehab technology is unique and differs significantly from standard DME
• Population served by CRT requires more highlyPopulation served by CRT requires more highly specialized services– Many products require a physical evaluationMany products require a physical evaluation
– Involves credentialed specialists
• CRT is subject to more stringent qualityCRT is subject to more stringent quality standards of compliance than other DME
Complex Rehab Technology:h ’ h ?What’s the message?
• Ask your Representative to co‐sponsor HR 942, Ensuring Access to Quality Complex R hbilit ti T h l A t f 2013 th tReahbilitation Technology Act of 2013 that would create a separate benefit category for Complex Rehab TechnologyComplex Rehab Technology
W ki tti S t• We are working on getting a Senate companion bill introduced
Competitive Acquisition Program:Wh t i it?What is it?
M di P i i D I d• Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) required bids to be submitted to select a limited number of suppliers tosubmitted to select a limited number of suppliers to provide and service certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), , pp ( )
• First round was initiated in 10 cities in July 2008, (stopped after two weeks), Round One Rebid began on January 1, 2011
• Program will expand to 91 additional cities on July 2013
CAP Affected Cities –d b dRound One Rebid
• Cincinnati – Middletown (Ohio, Kentucky and Indiana)• Cleveland – Elyria – Mentor (Ohio)• Charlotte – Gastonia – Concord (North Carolina and
South Carolina))• Dallas – Fort Worth – Arlington (Texas)• Kansas City (Missouri and Kansas)
Mi i F t L d d l P B h (Fl id )• Miami – Fort Lauderdale – Pompano Beach (Florida)• Orlando (Florida)• Pittsburgh (Pennsylvania)Pittsburgh (Pennsylvania)• Riverside – San Bernardino – Ontario (California)
CAP Product Categories –Round One Rebid
• Oxygen Supplies and EquipmentSt d d P Wh l h i S t d R l t d• Standard Power Wheelchairs, Scooters, and Related Accessories
• Complex Rehabilitative Power Wheelchairs and Related ( )Accessories (Group 2)
• Mail‐Order Diabetic Supplies• Enteral Nutrients, Equipment and SuppliesEnteral Nutrients, Equipment and Supplies• CPAP, RADs, and Related Supplies and Accessories• Hospital Beds and Related Accessories• Walkers and Related Accessories• Support Surfaces (Group 2 mattresses and overlays) in
Miami
CAP Affected Cities ‐ Round Two
WEST
Albuquerque, NMBakersfield‐Delano, CABoise City‐Nampa, ID
Portland‐Vancouver‐Hillsboro, OR‐WASacramento‐Arden‐Arcade‐Roseville, CAy p ,
Colorado Springs, CODenver‐Aurora‐Broomfield, COFresno, CA
Salt Lake City, UTSan Diego‐Carlsbad‐San Marcos, CASan Francisco‐Oakland‐Fremont, CA
Honolulu, HILas Vegas‐Paradise, NVLos Angeles‐Long Beach‐Santa Ana, CAO d Th d O k V t CA
San Jose‐Sunnyvale‐Santa Clara, CASeattle‐Tacoma‐Bellevue, WAStockton, CATucson AZOxnard‐Thousand Oaks‐Ventura, CA
Phoenix‐Mesa‐Glendale, AZTucson, AZVisalia‐Porterville, CA
CAP Affected Cities – Round TwoMIDWEST
Akron, OHAkron, OHChicago‐Joliet‐Naperville, IL‐IN‐WI
Columbus, OHDayton, OH
Detroit‐Warren‐Livonia MIDetroit Warren Livonia, MIFlint, MI
Grand Rapids‐Wyoming, MIHuntington‐Ashland, WV‐KY‐OH
Indianapolis Carmel INIndianapolis‐Carmel, INMilwaukee‐Waukesha‐West Allis, WI
Minneapolis‐St. Paul‐Bloomington, MN‐WIOmaha‐Council Bluffs, NE‐IA
St L i MO ILSt. Louis, MO‐ILToledo, OHWichita, KS
Youngstown‐Warren‐Boardman, OH‐PA
Round 2 CAP Affected CitiesAsheville, NC
Atlanta‐Sandy Springs‐Marietta, GAAugusta‐Richmond County, GA‐SC
Lakeland‐Winter Haven, FLLittle Rock‐North Little Rock‐Conway, AR
Louisville/Jefferson County KY‐IN
SOUTH
g y,Austin‐Round Rock‐San Marcos, TX
Baltimore‐Towson, MDBaton Rouge, LA
Beaumont‐Port Arthur, TXBirmingham Hoover AL
Louisville/Jefferson County, KY INMcAllen‐Edinburg‐Mission, TX
Memphis, TN‐MS‐ARNashville‐Davidson‐Murfreesboro‐Franklin,
TNlBirmingham‐Hoover, AL
Cape Coral‐Fort Myers, FLCharleston‐North Charleston‐Summerville,
SCChattanooga, TN‐GA
New Orleans‐Metairie‐Kenner, LANorth Port‐Bradenton‐Sarasota, FL
Ocala, FLOklahoma City, OK
Palm Bay‐Melbourne‐Titusville FLg ,Columbia, SC
Deltona‐Daytona Beach‐Ormond Beach, FLEl Paso, TX
Greensboro‐High Point, NCG ill M ldi E l SC
Palm Bay‐Melbourne‐Titusville, FLRaleigh‐Cary, NCRichmond, VA
San Antonio‐New Braunfels, TXTampa‐St. Petersburg‐Clearwater, FL
Greenville‐Mauldin‐Easley, SCHouston‐Sugar Land‐Baytown, TX
Jackson, MSJacksonville, FLKnoxville, TN
Tulsa, OKVirginia Beach‐Norfolk‐Newport News, VA‐NCWashington‐Arlington‐Alexandria, DC‐VA‐
MD‐WVKnoxville, TN
CAP Affected Cities ‐ Round TwoCAP Affected Cities Round TwoNORTHEAST
Albany Schenectady Troy NYAlbany‐Schenectady‐Troy, NYAllentown‐Bethlehem‐Easton, PA‐NJBoston‐Cambridge‐Quincy, MA‐NHBridgeport‐Stamford‐Norwalk, CT
Buffalo Niagara Falls NYBuffalo‐Niagara Falls, NYHartford‐West Hartford‐East Hartford, CT
New Haven‐Milford, CTNew York‐Northern New Jersey‐Long Island, NY‐NJ‐PA
Philadelphia Camden Wilmington PA NJ DE MDPhiladelphia‐Camden‐Wilmington, PA‐NJ‐DE‐MDPoughkeepsie‐Newburgh‐Middletown, NYProvidence‐New Bedford‐Fall River, RI‐MA
Rochester, NYScranton Wilkes Barre PAScranton‐Wilkes‐Barre, PA
Springfield, MASyracuse, NYWorcester, MA
CAP Product Categories –Round TwoRound Two
• Oxygen, oxygen equipment, and supplies• Standard (Power and Manual) wheelchairs scooters and related• Standard (Power and Manual) wheelchairs, scooters, and related
accessories• Enteral nutrients, equipment, and supplies• Continuous Positive Airway Pressure (CPAP) devices and
Respiratory Assist Devices (RADs) and related supplies and accessories
• Hospital beds and related accessories• Walkers and related accessories• Negative Pressure Wound Therapy pumps and related supplies• Negative Pressure Wound Therapy pumps and related supplies
and accessories• Support surfaces (Group 2 mattresses and overlays)
Consumer Impacts• Difficulty finding a local equipment or service provider
• Delays in obtaining medically required equipment and services (i.e. wheelchair repair)
• Longer than necessary hospital stays due to trouble di h i ti t t h b ddischarging patients to home‐based care
• Far fewer choices for patients when selecting equipment or providersor providers
• Reduced equipment, parts and service quality; and
• Confusing or inaccurate information provided by Medicare
Support fixing CAPSupport fixing CAPCurrent Program Problems:• Winning suppliers are NOT bound by their bids g pp yto provide DME
• Irresponsibly low supplier payment rates• Irresponsibly low supplier payment rates affecting your access to your choice of quality equipment and services
• No transparency in how suppliers win contracts or how consumer demand is calculatedor how consumer demand is calculated
Competitive Bidding: What’s the Message
W t l i l ti t fi th t biddi• We support legislation to fix the current bidding program.
• Legislation should be introduced in the next week or so (similar to legislation that we supported last year).
Y ill d f h l• You will see an update from us shortly.
Outpatient Rehab PaymentsMedicare arbitrarily caps at $1,900 annual payments for outpatient occupational therapy and outpatient physical
therapy and speech therapy combined py p py
• An extension of the therapy cap “exceptions” process allows Medicare beneficiaries to seek waivers to exceed the annual limit for medically necessary services
F ili th d l t b CMS f f i t• Failing the development by CMS of a fair payment method, this exceptions process has required enactment of annual exceptions legislation since 1997
• The current exceptions process extension will end December 31, 2013 ,
Outpatient Rehab Payments• Congressmen Jim Gerlach (R‐PA) and Xavier Becerra (D‐CA) and
Senators Ben Cardin (D‐MD) and Susan Collins (R‐ME) introduced Th M di A R h bili i S i A f 2013 (HRThe Medicare Access to Rehabilitation Services Act of 2013 (HR 713/S 367). HR 713 has 26 cosponsors. S. 367 has 8 cosponsors.
• The bill would repeal the arbitrary Medicare Part B outpatient therapy caps now affecting an estimated 640,000 Medicare beneficiaries being denied access to needed services
• Ending the therapy cap would ensure that Medicare beneficiaries recovering from spinal cord injury and disorders g p j yreceive the therapy they need to live productive, independent lives and avert costing Medicare more due to increased hospitalizations
Outpatient Rehab Payments: What’s h ?the Message?
• Urge your Representative and Senators to co‐sponsor HR 713/S 367 to eliminate Medicare’s arbitrary and unfair y foutpatient rehab therapy payment caps
What are ‘Specialty Tier’ Drugs• Part D Prescription Plans establish formularies that list the specific drugs they cover, either:– 25 percent co‐insurance for all covered drugs, or – tiered cost‐sharing (generic, preferred, non‐preferred, specialty tier – high cost, unique drugs)specialty tier high cost, unique drugs)
– prescription drugs costing more than $600/month may be placed on ‘specialty tier’
O t f 44 PDP (89% f ll PDP ti id ) 38 PDP• Out of 44 PDPs, (89% of all PDPs nationwide), 38 PDPs use a specialty tier* – one of the top 10 covered specialty drugs listed in 38 PDPs p p y gis Copaxone which is one treatment for multiple sclerosis
*( di d )*(KFF, Medicare Part D 2009 data)
Specialty Tier DrugsSpecialty Tier Drugs
• On Medicare specialty tiers – Rep. Hank Johnson ( th ) l i d hi bill hi(D‐4th GA) plans to reintroduce his bill this year
W l l ki t S t i• We are also looking at Senate companion legislation
• We are concerned about potential cuts to Medicare Part D as Congress searches for ways to cut Medicare spendingto cut Medicare spending
Specialty Tier Drugs: h ’ h ?What’s the message?
l f l• Support implementation of an appeals process under Medicare Part D for individuals h d d ‘ i l i ’ dwho are dependent on ‘specialty tier’ drugs
• We will update our members and Team Advocacy list when the new legislation is y gintroduced
RECAP MESSAGESRECAP MESSAGES• Ask your Representative to co‐sponsor HR 942 that would
create a separate benefit category for Complex Rehabcreate a separate benefit category for Complex Rehab Technology
• We support legislation to fix the current bidding programWe support legislation to fix the current bidding program
• Urge your Representative and Senators to co‐sponsor HR 713/S 367 to eliminate Medicare’s arbitrary and unfair713/S 367 to eliminate Medicare s arbitrary and unfair outpatient rehab therapy payment caps
• Support implementation of an appeals process under• Support implementation of an appeals process under Medicare Part D for individuals who are dependent on ‘specialty tier’ drugs
Get Involved and Make a Difference• Become a member of United Spinal Association
www.unitedspinal.org
• Join United Spinal Association’s Team Advocacy www.unitedspinal.org – visit our Advocacy Action Center
• Join a chapter/support group www.spinalcord.org
• Be a policy advisor at your chapter/support groupwww.spinalcord.org
• Be a grassroots advocatewww.usersfirst.orgg
More Ways to Get Involved• Attend a town hall hearing/meeting in your state• Attend a town hall hearing/meeting in your state
• Find your Senator at www senate gov and your
Senator Tom Harkin (D‐IA), Chair, Senate HELP Committee
• Find your Senator at www.senate.gov and your Representative at www.house.gov
C ll U S C it l S it hb d (202) 224 3121• Call U.S. Capitol Switchboard: (202) 224‐3121
• Or you canOr you can
Roll on Capitol Hill, p ,June 16‐19, 2013
United Spinal Association’s Annual Legislative and Advocacy Conference
• United Spinal’s public policy department
• NSCIA – United Spinal’s membership and chapter division
• Users First – United Spinal’s grassroots advocates division
You can find more information at:
http://www.unitedspinal.org/events/roll‐on‐capitol‐hill/http://www.unitedspinal.org/events/roll on capitol hill/
THANK YOUQUESTIONS?
To ask me a question or make a comment, please type it in the “Questions” boxQuestions box
[email protected](202) 556‐2076, x.7102
