Presenter 

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. Thomas