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Consumer Advocacy in Minnesota

Wednesday, February 22, 2012 @ 09:02 AM  posted by jbuytaert

Dear Complex Rehab Team Member,

Your assistance is urgently needed!

I had a call from Alex Bennewith, the director of Government Relations at United Spinal Association. Alex and other NCART work group members are preparing to ask Minnesota Representative Erik Paulsen (R),  to introduce legislation to create a Separate Benefit Category for Complex Rehab Technology within the Medicare program.  She is requesting assistance in the form of letter writing to Rep. Paulsen from consumers in Minnesota. I am reaching out to you as suppliers and clinicians asking for your assistance in getting this information to our Minnesota adult consumers who have Medicare. You may also send this to all consumers, as we know that whatever Medicare does will affect Medicaid and private payers policy very quickly.

Below is a template letter to Representative Paulsen. According to Alex, Paul Tobin, President and CEO of United Spinal Association, hopes to meet with Representative Paulsen to discuss the need for this essential legislation by Friday of this week. 

The sooner the letters are faxed or emailed to Representative Paulsen, the better for all consumers of Complex Rehab Technology.

Rep. Paulsen’s contact information is listed below.

127 Cannon House Office Building,
District of Columbia 20515-2303
Phone: (202) 225-2871
Fax: (202) 225-6351

DRAFT LETTER TO REP PAULSEN SEEKING SUPPORT OF SEPARATE BENEFIT CATEGORY LEGISLATION

 [DATE]

 The Honorable Erik Paulsen
127 Canon House Office Building
Washington, D.C. 20515

Dear Representative Paulsen:

My name is [INSERT PERSONAL DETAILS, RE DISABILITY, LIMITATIONS, ROLE COMPLEX REHAB PLAYS IN YOUR LIFE, HOW AN IMPROVED BENEFIT CATEGORY WOULD POSITIVELY HELP YOU, ETC. – INCLUDE YOUR ADDRESS, CLINICAL INSTITUTIONS/CLINICIANS YOU DEAL WITH, HISTORY OF DISABILITY ETC.] 

I am writing to ask you to support legislation to create a Separate Benefit Category for Complex Rehab Technology within the Medicare program.

A separate benefit category for CRT within the Medicare Program is necessary to ensure beneficiary access to critical assistive devices for beneficiaries with disabling conditions. The current benefit structure presents serious and often insurmountable obstacles for individuals who need CRT to achieve high levels of function in order to achieve good health outcomes, live independently, be employed where possible, care for their loved ones, engage in civic functions, and perform everyday activities.

[INSERT PERSONAL OBSERVATIONS ABOUT LIMITATIONS OF CURRENT MEDICARE BENEFIT AND CONSUMERS’ ABILITY TO ACCESS MOST APPROPRIATE ITEMS AND SERVICES] I believe that this decline is due to funding restrictions that stem from coding, coverage, and payment problems.   I believe these problems would be remedied by the CRT community’s legislative proposal for a separate CRT benefit within the Medicare program.

CRT includes a broader baseline of services than those that are currently referred to under the Medicare program as “durable medical equipment” or “DME.” CRT is prescribed and customized to meet the specific medical and functional needs of individuals with disabilities and medical conditions such as, but not limited to, Cerebral Palsy, Muscular Dystrophy, Multiple Sclerosis, Spinal Cord Injury, Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease), and Spina Bifida. However, because CRT is currently coupled with the more general DME benefit, these patients face a series of challenges trying to access the appropriate and necessary technologies and services. These challenges include:

  • Hindrance of the pairing of an individual’s needs to the appropriate products and technology due to coverage policies that are based on diagnosis instead of a person’s functional needs;

 

  • Severe limitations on devices to be used outside of the home and in the community, due to Medicare’s restrictive interpretation of the “in the home” requirement for DME;

 

  • Threats to patient access by the inclusion of CRT products in Medicare’s DME Competitive Bidding program, a program that could threaten patient access to specialized technology. (While Group 3 complex rehabilitation wheelchairs were exempt from competitive bidding, other items such as configurable manual wheelchairs, tilt-in-space wheelchairs and custom seating and positioning items are still at risk);

 

  • Lack of access to local CRT suppliers and long delays for repairs and maintenance for CRT due to insufficient reimbursement for these specialized devices and services; and

 

  • Reductions in coverage for CRT when State Medicaid programs cut DME benefits.

I strongly urge you to take the lead on a bill to establish a new and separate benefit category for Complex Rehab Technology products and services that recognizes the customized nature of the technology and the range of services necessary to meet the unique medical and functional needs of people with disabilities and complex medical conditions.  

Sincerely,

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