Ensuring Access to Quality CRT

On March 4, 2013, Representatives Jim Sensenbrenner (R-WI) and Joe Crowley (D-NY) introduced in the U.S. House of Representatives a bill that would create a separate Medicare benefit category for Complex Rehab Technology (CRT). H.R. 942 “Ensuring Access to Quality Complex Rehab Technology Act of 2013” would provide appropriate recognition and coverage of CRT, which is defined as medically necessary and individually configured manual wheelchairs, power wheelchairs, adaptive seating and positioning systems and other specialized equipment such as standing frames and gait trainers. The bill would require the Medicare program to make necessary coding, coverage and payment changes, and enhance CRT supplier standards to improve and protect access for people with disabilities who rely on CRT for their medical and functional needs. At press time Senator Charles Schumer (D-NY) pledged to introduce a companion bill in the Senate. The Senate companion bill is a significant development as Senator Schumer is a senior democrat in the Senate and a member of the powerful Senate Finance Committee.

Though complex rehab technology is a relatively small portion of durable medical equipment (DME) items and expenditures, like the provision of orthotics and prosthetics it requires a specialized evaluation by a therapist and a credentialed CRT supplier to ensure that the consumer obtains the most clinically and functionally appropriate technology.

The bill would require Medicare to separately cover CRT items that are configured for a specific individual to meet that individual’s unique: 1) medical, physical and functional needs related to a medical condition and; 2) capacities for basic activities of daily living (ADLs) and instrumental ADLs. Technically, the bill would designate certain HCPCS codes as being CRT codes (some HCPCS codes would simultaneously remain in the DME benefit) and require Medicare to establish separate coverage criteria for the CRT codes. By way of example, eligibility requirements would include physical and functional needs and capacities arising from medical conditions such as congenital disorders, progressive or degenerative neuromuscular diseases, or injuries or trauma that result in significant physical or functional needs and capacities; spinal cord injury, traumatic brain injury, cerebral palsy, muscular dystrophy, spina bifida, osteogenesis imperfecta, arthrogryposis, amyotrophic lateral sclerosis, multiple sclerosis, demyelinating disease, myelopathy, myopathy, progressive muscular atrophy, anterior horn cell disease, post-polio syndrome, cerebellar degeneration, dystonia, Huntington’s disease or spinocerebellar disease; and types of amputation, paralysis, or paresis that result in significant physical or functional needs and capacities.

Other key provisions of the bill would eliminate the “in the home” coverage restriction for CRT that Medicare applies to the provision of DME, and an exclusion from the Medicare DME bidding program of all CRT items (some CRT items are already excluded by law).

In mid-April almost 200 consumers, clinicians, providers and manufacturers participated in the National CRT Leadership and Advocacy Conference to urge their members of Congress to support  and pass H.R. 942. A CRT Congressional Call-In Day was also held. If you didn’t get a chance to contact your federal legislators about this bill, now is the time. Here are a few tips:

A summary of the legislation, a list of national supporters and a slew of other materials you can use with your legislators can be found online at www.access2crt.org. The message is simple: Ask your representatives to sign on to H.R. 942 as a co-sponsor. Visit your legislators’ local offices. Optimally, you should include a consumer in these visits. Visuals are helpful in effectively conveying what we are discussing. The website provides a video and document with photographs (see the “Proposal Paper” on the site) that provides some great visuals.

This initiative is led by the National Coalition for Assistive & Rehab Technology, the American Association for Homecare, the National Registry of Rehabilitation Technology Suppliers, the Rehabilitation Engineering and Assistive Technology Society of North America, the Clinician Task Force, the United Spinal Association and the Independence Through Enhancement of Medicare and Medicaid Coalition.