Protecting Access to Complex Rehab Technology


Don Clayback Executive Director, National Coalition for Assistive and Rehab Technology
Don Clayback
Executive Director,
National Coalition for Assistive and Rehab Technology

Medicare’s Durable Medical Equipment benefit category was created over 45 years ago to cover the basic medical equipment needs of elderly individuals. Over time technology has advanced to include highly configurable manual wheelchairs, power wheelchairs, adaptive seating and positioning systems, and other specialized equipment such as standing frames and gait trainers.

This technology — called complex rehab technology — is prescribed and individually configured to meet the specific medical needs of people with disabilities and maximize their function and independence. Unfortunately these specialized products are classified within the broad DME benefit category even though CRT is very different from standard DME.

To protect access to CRT for people with disabilities, the “Ensuring Access to Quality Complex Rehabilitation Technology Act” has been introduced in Congress. The bill will create a separate benefit category for CRT within Medicare like the one that exists for Orthotics and Prosthetics (custom braces and artificial limbs).

Like Orthotics and Prosthetics, the CRT provision involves configuring a set of technology to the specific medical and functional needs of the individual, working through a clinical team model, necessitates credentialed and experienced providers, and requires ongoing supporting services.

Passage of the separate benefit category legislation will provide needed improvements in the areas of coverage, coding, and quality standards. The bill is designed to:
• Develop clearer and more consistent coverage policies to better address the unique needs of individuals with varied disabilities.
• Establish strong and enforceable provider standards to promote better outcomes and consumer protection.
• Provide stability to ensure continued access to products and services and an environment that encourages product research and development.
• Produce an improved coverage model within Medicare that can be offered to Medicaid and other payers to follow.

A separate benefit category for CRT will provide needed changes to protect access that will benefit not only Medicare beneficiaries with significant disabilities such as spinal cord injury, amyotrophic lateral sclerosis, multiple sclerosis and spina bifida, but the Medicare program as a whole. In addition, once these needed changes are put in place within the Medicare program they will spread to state Medicaid programs and private health insurance plans.

Legislative Progress

Getting legislation introduced and passed in Congress is a long and arduous process. When the separate benefit category initiative began, CRT stakeholders were informed that the process of getting the bill passed would be a marathon, not a sprint. And so it has been. But while we have not crossed the finish line, we have passed major mile markers each year and are making solid progress to ultimate passage. Here’s an overview of the yearly progress:

2012: CRT bill initially introduced in April in the House of Representatives; ended the year with 36 representatives signed on.

2013: New session of Congress; bipartisan House bill reintroduced and bipartisan companion Senate bill introduced; ended the year with 86 representatives signed on to the House bill and seven senators signed on to the Senate bill.

2014: Continued outreach to Congress; ended the year with 168 representatives signed on to the House bill and 22 senators signed onto the Senate bill.

2015: New session of Congress; bipartisan House and Senate bill reintroduced; getting last year’s co-sponsors to sign on again, securing new co-sponsors and focusing on passage this year.

Vanessa Cizmar demonstrates her standing chair, which is an example of complex rehab technology.
Vanessa Cizmar demonstrates her standing chair, which is an example of complex rehab technology.

As noted above, while we did not get the CRT bill passed in the last congressional session, we have established an excellent foundation to move it over the finish line this year. We ended 2014 with 168 representatives signed on to HR-942 and 22 senators signed on to S-948. That’s 190 members of Congress supporting CRT legislation!

This progress is a direct result of a wide cross section of CRT stakeholders taking the time to reach out to their representatives and staff through emails, phone calls, social media and in-person meetings. We know it is not easy to do this outreach with all the other demands on people’s time. But we have proven that commitment and persistence pays off. An important part of this progress is the broad support from over 50 national consumer and medical and professional organizations that have formally gone on record supporting passage of the legislation.

Our progress is significant and we need to recognize that. Everyone’s hard work is paying off and the CRT message is spreading. However, our main objective remains to get the bill passed. Passage is critical to protect access to CRT for people with disabilities who rely on this specialized equipment and the related supporting services. The need for this legislation is increasing as the threats and challenges to access continue to grow at both the federal and state levels.

What Lies Ahead for 2015

This year is of particular significance as the country celebrates the 25th Anniversary of the Americans with Disabilities Act. As we look to 2015 we have a great base to start from. The legislation has been reintroduced in Congress and has been assigned bill number HR-1516 in the House and S-1013 in the Senate.

While the ADA has resulted in improvements in community access, those improvements can represent unfulfilled promises if someone can’t get the right wheelchair. This is the perfect year to make sure the “Ensuring Access to Quality Complex Rehabilitation Technology Act” passes and the coverage, coding, and quality standards needed to promote and protect access for wheelchair users are put in place.

To take action now on the CRT legislation and urge your members of Congress to sign on to the bill, visit our website at www.unitedspinal.org/separate-medicare-crt/.


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