May 07, 2013 Theresa T. Morgan ITEM Coalition Staff Powers Pyles Sutter & Verville, P.C itemcoalition.org

2  Over 65 national and local non-profit organizations focused on expanding access to medical devices and assistive technology for individuals with disabilities  Consumer and clinician-led, our steering committee members are: ◦ ASHA ◦ United Spinal ◦ NMSS ◦ AFB ◦ PVA  Includes a diverse set of organizations ◦ disability organizations ◦ non-profit provider and supplier associations ◦ RESNA and ATAP are members

3  Engaged in a sustained education and advocacy campaign to raise awareness among policymakers of the critical importance of adequate access to assistive devices, technologies and related services  Building support for legislative and regulatory changes to address this problem through enhancing current coverage policies  Promotes a broad-based assistive device benefit that helps as many users of assistive devices, technologies, and related services as possible

4  Membership is open to all national non-profit organizations who support the ITEM Coalition mission, without any requirement to contribute financially  Steering committee meets once a month  Members meet annually, and receive updates and opportunities to advocate for broader coverage through regulations, legislation and education

5  ITEM supports the Ensuring Access to Quality Complex Rehabilitation Technology act of 2013 (HR 942) ◦ Would create a separate category from the current Medicare DME category ◦ Introduced 3/4/2013 ◦ Sponsored by Rep Crowley [NY-14] ◦ Referred to the Health Subcommittee in both the House Energy and Commerce Committee and House Ways and Means Committee ◦ No Senate version at this time ◦ 24 Cosponsors  16 Democrats  8 Republicans

 HR 942 defines CRT as items: ◦ Designed and configured for a specific qualified individual to meet the individual’s unique medical, physical and functional needs and capacities for basic activities of daily living; and items which are ◦ Primarily used to serve a medical purpose and is generally not useful to a person in the absence of illness or injury; and items ◦ Requiring specialized services and evaluation to ensure the features and functions of the item meets the needs of the specific individual 66

 Individuals who might need access to CRT include, but are not limited to, individuals with: ◦ Congenital disorders, progressive or degenerative neuromuscular diseases ◦ Spinal cord injury ◦ Traumatic brain injury ◦ Cerebral Palsy ◦ Multiple Sclerosis ◦ Myopathy ◦ Huntington’s Disease ◦ And other low incidence conditions which impede an individual’s function and ability to live independently 77

8  7% of Medicare  Intended for progressive diagnoses  Provides positioning  Accommodates deformity  Provides pressure management  Offers ventilator accommodation  93% of Medicare  Intended for ambulatory limitations  Basic joystick drive only  Provides no positioning  No deformity accommodation  Provides no pressure management  No ventilator accommodation Complex Power WCsStandard Power WCs

9  CMS, in consultation with Office on Disability, VA, DOD and others would standardize access by: ◦ designating certain technology as CRT, and ◦ creating an eligibility process by which individuals with certain physical and functional needs could access that technology  Remove the restriction on coverage to CRT when it can be helpful outside of the individual’s home  Improve program safeguards by increasing quality standards for suppliers of CRT items above current DME standards  Allow beneficiaries in skilled nursing facilities to obtain CRT items when transitioning to the community

 Competitive bidding Mandated by Congress thru the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and subsequent legislation  Medicare must replace fee schedule payment method for DMEPOS with a competitive bid process ITEM Coalition is surveying beneficiaries to assess problems or disruptions in access In round one, on average reimbursement dropped 32 percent in the nine markets Phase 2 will be launched on July 1, 2013, in 91 areas, with an average reimbursement cut of 45 percent All areas of the country could be under competitive bidding by 2016 Some CRT is already exempt from bidding, HR 942 would require the formal category be entirely exempt from the bidding program 10

11  Go to itemcoalition.org or  Contact me! ◦ ◦