PLENARY II
Rehabilitation Policy’s Impact on Providers and People with Physical Disabilities

 

Presenter 

Peter W. Thomas, J.D. 
Principal
Powers Pyles Sutter & Verville

 

Description

As clinical practice in rehabilitation evolves, so does federal policy that impacts persons with physical disabilities and chronic conditions. Federal policy often drives clinical practice. This presentation will provide an overview of policies that impact a wide range of rehabilitation providers, both institutions and rehabilitation professionals, as well as the consumers and beneficiaries who rely on these providers to regain health, function and quality of life after illness or injury. The presentation will begin with an overview of developments in post-acute care (PAC), movement to a uniform PAC payment system, evolution to a value-based PAC system that financially rewards quality, efforts to enhance quality improvement and measurement of outcomes, the role of function in PAC reform, coverage, coding and reimbursement of rehabilitation services and devices in a variety of settings and many other Medicare and other federal policies. The presentation will also focus on Medicare audits and appeals, denials of claims, Medicare Advantage tactics to limit access to rehabilitation, and potential efforts to expedite appeals through the ALJ appeals process through global settlement efforts. Finally, the overview will include a synopsis of the importance of the Affordable Care Act, how that law established a federal essential health benefits package that includes coverage of rehabilitation and habilitation services and devices, and recent regulatory efforts to allow states greater flexibility to offer less expensive, less comprehensive coverage, leading to an erosion of the federal protections in private insurance for people with health conditions, particularly people with disabilities and chronic medical conditions. A small panel of Chicago-based individuals (one with brain injury and one with spinal cord injury) who have experienced comprehensive rehabilitation post-injury or illness will then discuss personal challenges they have encountered with the health care system to illustrate some of the points highlighted in the policy overview. If necessary to satisfy requirements for CEU’s, an academic/researcher in rehabilitation will discuss emerging areas of promise for rehabilitation treatments to address some of the concerns raised by the policy speaker and the consumer testimonials.

 

Learning Objectives

  • To understand the primary federal health care policies that impact rehabilitation providers and patients
  • To understand trends in these policies and where future legislative and regulatory changes may emerge
  • To understand the importance of these policies to address the real-world needs of people with physical disabilities

About Dr. Putrino

Peter W. Thomas is a principal with the Washington, DC based law firm of Powers, Pyles, Sutter & Verville. He has been a legislative and regulatory advocate for over twenty years on behalf of health care and post-acute care providers as well as consumers with injuries, illnesses, disabilities and chronic conditions. He represents the American Medical Rehabilitation Providers Association (AMRPA) before Congress and the federal agencies as well as associations that represent physiatrists, orthotic and prosthetic providers and consumers, recreational therapists, and brain injury providers and consumers, among others. Mr. Thomas has personal experience with physical disability, wearing two prosthetic limbs below the knees since age ten. Mr. Thomas helps coordinate multiple coalitions focused on health and disability advocacy, rehabilitation research policy and funding, and access to rehabilitation services and devices. He serves on the American Trauma Society board of directors where he chairs the Trauma Survivors Network Committee and is part of a team funded by PCORI to study patient-centric improvements to trauma care. Mr. Thomas also serves on the National Quality Forum’s Patient and Family Centered Care Committee which evaluates and validates functional and quality of life measures. He also served on the President’s Commission on Consumer Protection and Quality in the Health Care Industry, served three years on the Advisory Board for the Agency for Healthcare Research and Quality, and served five years on the Advisory Board for the National Center for Medical Rehabilitation Research at NIH. He has testified numerous times before Congress, authored hundreds of articles on health and disability policy, and is a co-author of a book on implementation of the Americans with Disabilities Act. He attended Georgetown University Law Center and Boston College, and is a member of the New York State and District of Columbia Bars.

 

ACRM ANNUAL CONFERENCE // HILTON CHICAGO // 5 – 8 NOV 2019

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