Monthly Archives: May 2015

Problems with Cost Plus Payment in CRT

Learn more about the problems with Cost Plus Payment and exploring some alternative paying methods.

Learn more about the problems with Cost Plus Payment and exploring some alternative paying methods.

 

Complex Rehab Technology (CRT) products are specialized and customized to fit each individual’s needs. These products are provided to individuals with significant disabilities in order to address their medical and functional needs.

When determining the cost of CRT products, the cost of the product, cost of the service, delivery and support system must be recognized. The cost of the product itself is only about half of the actual cost of providing the equipment. CRT studies have found that for every dollar of funding, product cost is approximately 49 cents and service cost is approximately 46 cents. To make sure that people with disabilities are able to access the CRT equipment they need, a funding system must incorporate the total costs of providing the product and the supporting services. Because of these operational and financial challenges, there are only a limited number of companies that will supply CRT and that number is decreasing.

Problems with Cost Plus Payment Methodology

  1. Unless the Cost Plus methodology incorporates all costs of products and services with an appropriate multiplier, it does not provide appropriate payment rates.
  2. A Cost Plus system is time consuming for the payer. Since CRT orders are so complex, there may be 20 to 30 invoice line items to review on each claim. This creates additional administrative burdens.
  3. A Cost Plus system penalizes CRT suppliers and rewards companies that don’t. Because dedicated suppliers buy more products, they will typically have a lower product cost compared to the company that buys fewer products. The result of this is a supplier getting paid less than a company that has made a smaller investment.
  4. A Cost Plus system reduces the supplier’s desire to negotiate better acquisition costs.

Alternative Payment Methodologies  

  1. Use published Medicare Fee Schedule to ensure that the most current fee schedules are in place.
  2. Use Manufacturer’s Suggested Retail Pricing (MSRP) to decrease the likelihood that a supplier will provide a low quality product.
  3. Use a combination of Medicare Fee Schedule and MSRP. Use the Medicare Fee Schedule for coded items and MSRP for non-coded items.

There are a number of problems with applying the Cost Plus payment methodology to CRT. The National Coalition for Assistive and Rehab Technology (NCART) works hard to make sure that individuals with disabilities have access to CRT products and services. Contact us to find out how you can help!

CRT Stakeholders Call on Lawmakers to Protect IL Medicaid Beneficiaries

FOR IMMEDIATE RELEASE
May 19, 2015

CONTACT
Don Clayback, NCART Executive Director, 716-839-9728, dclayback@ncart.us

Coalition of Complex Rehab Technology stakeholders call on Illinois Lawmakers to protect, not punish, Medicaid beneficiaries with severe disabilities

Urgent action needed to reverse payment cuts and ensure
people with disabilities access to specialized wheelchairs and adaptive equipment
Buffalo, New York – A coalition of Complex Rehab Technology (CRT) stakeholders made up of people with disabilities, medical professionals, disability rights advocates, and CRT providers from across Illinois are sending an urgent message to state lawmakers – in the quest for Medicaid cuts, don’t punish Illinois Medicaid beneficiaries who need specialized CRT products and services. To restore access and prevent negative consequences, recent payment policy changes and cuts to CRT must be rescinded now.

Kim Brown, the 2012 Ms. Wheelchair Illinois, has joined the effort because she is concerned and does not want to see lawmakers overlook the needs of the tens of thousands of people with disabilities in Illinois. Brown was born with Spina Bifida but she wants everyone to know that hasn’t held her back.

She has earned two Master’s degrees, is a Senior Business Analyst in Chicago, and states CRT is very important to her. “My wheelchair is basically my legs,” Brown said. “The equipment I use is highly specialized and individually tailored to fit my needs. I use my chair every single day. I urge Illinois lawmakers to rescind these cuts to protect access for the many people who, like me, have Complex Rehab Technology needs.”

As a result of recent policy changes and payment cuts the two largest CRT providers in the state have had to temporarily suspend all but emergency services to the Medicaid program. The availability and proper provision of CRT products and supporting services enables people with disabilities to address their medical needs and maximize their independence. It also plays a key role in helping the state control and reduce Medicaid costs.

“There are only a handful of qualified companies who provide these specialized wheelchairs and adaptive equipment to Illinois Medicaid beneficiaries.” said Don Clayback, Executive Director of NCART. “If nothing is done to reverse these major cuts, this drop in access will significantly compromise the health and independence of children and adults with disabilities and at the same time increase the cost for medical care and hospitalization.”

Unfortunately access to this specialized equipment has been reduced due to major Medicaid payment cuts. In the last 30 days Illinois CRT companies that supply these products have been hit with multiple unexpected cuts from (1) an unannounced April change in the CRT payment methodology and (2) a just announced May 1st across-the-board payment cut of 16.75%. As a result, the two largest CRT providers in the state have been forced to temporarily suspend the provision of almost all products and services.

Jill Sparacio is an occupational therapist in Chicago and has been in practice for over 25 years. She works with children and adults with disabilities who require specialized wheelchairs and other adaptive equipment. “The important role that CRT plays can’t be overstated. Are the savings in cuts to CRT going to be noticeable in terms of the state’s budget compared to the detriment that the cuts will cost? Any savings that causes reductions in access will be more than offset by increased costs for resultant medical care, need for increased assistance within a person’s home, as well as loss of income by putting a person’s job in jeopardy.”

Sparacio continued “What’s truly unfortunate is that many of the people impacted by these cuts have severe disabilities and have no voice or ability to advocate for themselves. The state needs to find a way to deal with the budget issues without hurting this frail population.”

The coalition of CRT stakeholders is asking lawmakers to fix these access problems by working with the Illinois Department of Healthcare and Family Services to rescind the recent changes to payment rates and policies.

“While everyone understands the need for the state to closely examine and make changes in the Medicaid program, such changes should not be at the expense of the people in the state who have the greatest needs. We are sending an urgent message to lawmakers to do the right thing for people with disabilities who require this equipment.” said Melissa Pickering, Executive Vice President of Payer Relations for Numotion.

“The people our companies serve typically require care twenty four hours a day, seven days a week,” said Ed Curley, Vice President of Business Development and Payer Relations for National Seating & Mobility. “The equipment we provide to our customers is something they depend on every single day. All we are asking is for the state to recognize the specialized needs of people with severe disabilities and make needed changes to protect them and their families.”

ABOUT NCART

NCART, the National Coalition for Assistive and Rehab Technology, is a national organization of suppliers and manufacturers of Complex Rehab Technology (CRT) products and services used by people with significant disabilities and chronic medical conditions. NCART seeks to ensure these individuals have appropriate access to CRT products and supporting services. In pursuit of that goal, NCART works with consumers, clinicians, and physicians along with federal, state and private policy makers to establish and protect appropriate coverage, coding, and quality standards. Find out more at www.ncart.us.

4 Tools to Tell the CRT Story

NCART provides all of the materials you need to get the word out about Complex Rehab Technology.

NCART provides all of the materials you need to get the word out about Complex Rehab Technology.

It is an important time to be spreading the message about Complex Rehab Technology (CRT) and increasing awareness everywhere. Policy makers and other influential leaders need to understand what CRT is, who uses it and the benefits it brings them. The process of spreading the word about CRT is ongoing and often challenging. Fortunately, we have helpful tools that you can use to tell the CRT story to those who don’t know.

  1. Intro to CRT Video – “Complex Rehab Technology. Essential for health. Essential for life.” This video presents the perspectives of the people who depend on CRT for their health and independence, the physicians who prescribe it, and consumer organizations that work to protect CRT access.
  2. Complex Rehab Technology – Facts and Figures. This is a one page document that is designed to give a brief overview of CRT and works well as an introductory piece. It provides five key messages that set CRT apart from other options like DME and Orthotics and Prosthetics.
  3. “Complex” written by Mark Sullivan. This compelling booklet uses photographs and narratives to profile people that use CRT, explain its benefits, and explain how it is provided.
  4. CRT Company Overview. This document gives an overview of the products, people, processes and costs involved in being a CRT supplier business. It also covers the delivery process and business costs.

NCART provides a lot of information to help you in your advocacy efforts in the Educational Material section of our website. When presenting to someone about CRT, it is important not to overwhelm them with all of these documents at once. Be sure that you use them strategically. It is usually best to start with just one or two documents to provide an overview. You can supply more detailed information as time goes on. If you are feeling discouraged, remember that every educational conversation you have with someone who isn’t informed about CRT is one step closer to getting CRT the recognition needed to protect those who depend on it.

NCART - 54 Towhee Court - East Amherst, NY 14051 - Office: (716) 839-9728 - Fax: (716) 839-9624

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