Toward a CRT Benefit

Over the last two years, a lot of people in our industry have come together with representatives of the clinical and consumer communities to craft a detailed proposal for Congress to create a separate Medicare benefit category for what is being called “complex rehab technology,” or “CRT,” so that consumers can be assured appropriate access to this critical technology and related services.

The current Medicare durable medical equipment benefit does not adequately differentiate CRT and the related services required. A separate benefit category would appropriately distinguish and address the unique needs of individuals with disabilities and medical conditions who require these products and services.

The DME benefit was created over 40 years ago to address the medical equipment needs of elderly individuals. Over the years, available technology has advanced and now includes complex rehab power wheelchairs, highly configurable manual wheelchairs, adaptive seating and positioning systems and other specialized equipment such as standing frames and gait trainers.

CRT is used by individuals with serious medical conditions different from the traditional senior Medicare population. This population group, who tend to qualify for Medicare based on their disability and not their age, consists of individuals with disabilities and medical conditions such as cerebral palsy, muscular dystrophy, multiple sclerosis, spinal cord injury, amyotrophic lateral sclerosis (Lou Gehrig’s disease) and spina bifida.

CRT requires a broader range of services and specialized personnel than what is required for standard DME. The provision of CRT is done through an interdisciplinary team consisting of, at a minimum, a physician, a physical therapist or occupational therapist and a Rehab Technology Professional (RTP), referred to as the CRT team.

Devices in this category require a technology assessment completed by a certified RTP employed by a complex rehab technology company. This involves matching the medical and functional needs of the individual with the appropriate products. Simulations or equipment trials are often used to ensure that the items are appropriate and meet the person’s identified needs.

Many of the CRT products require a physical evaluation, a technology assessment, measuring, fitting, simulations and trials, a mixing and matching of products from different manufacturers, significant training and education and refitting and ongoing additional modifications.

Congress has acknowledged complex rehab power wheelchairs are unique and more specialized than standard DME. In 2008, it passed legislation exempting these products from the Medicare DME competitive bidding program, recognizing that including these items could jeopardize access to this customized technology.

In addition, CMS has recognized the unique nature of other customized products and services and created a separate and distinct classification for orthotics and prosthetics. CMS acknowledged the specialized service component inherent in custom-fit orthotics and prosthetics and treats O&P as separate and unique with its own medical policies, accreditation standards and reimbursement methods.

Our next step in the process is to get bills introduced in both the House and Senate to create the separate benefit.

Another objective of this initiative is to provide a model for the state Medicaid programs (and other payers) to help establish a uniform CRT benefit across all payers.

The National Coalition for Assistive & Rehab Technology (NCART), the American Association for Homecare (AAHomecare), the National Registry of Rehab Technology Suppliers (NRRTS) and the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) are working together on this initiative, which is supported by 18 national consumer organizations and 10 national clinical organizations.

For more information, you can find a copy of the detailed proposal paper for the separate benefit at www.ncart.us or www.aahomecare.org.

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A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her at 440/329-6226 or [email protected].