Keeping CRT Reforms Rolling

Next month, Wayne Grau will mark his one-year anniversary as the executive director of the National Coalition for Assistive and Rehab Technology (NCART). Grau has worked in complex rehab technology (CRT) at Pride Mobility and has also worked in government affairs for the MED Group and been director of business development for MK Battery. HomeCare chatted with Grau about how things are going approaching the 12-month mark.

HomeCare: What are some of NCART’s priorities for the rest of the year?

Grau: We’ve got three top priorities for 2023. No. 1 is definitely reimbursement adjustments on equipment and on repairs. Providers are just not reimbursed for all the services that they do, and you know, it sounds kind of crazy, but travel time is not reimbursed, diagnosis time is not reimbursed; often evaluation time is not reimbursed. An evaluation can take an hour or even two or three hours if you’re trying to bring together different manufacturers to fit a chair to a customer, so that’s a huge investment, and our guys just need to be reimbursed properly. All we’re asking for is to be reimbursed properly for the services that we provide.

We’re also over putting Band-Aids on service and repair. There are a number of issues that the industry feels like will help solve the problem. We need to focus on not just on one thing that will alleviate a little bit of this or that—it needs to be a comprehensive approach to reform.

And then the third priority is getting (reimbursement for) seat elevation and power standing across the finish line in a positive manner. (Seat elevation reimbursement was approved, but) the Centers for Medicare and Medicaid Services (CMS) has been very quiet on power-standing systems, which are just an incredible product and can bring so much help to the individuals that need those.

Those are the three things that we’re going to stay focused on through the end of the year and continue to try to drive more value to our members. If we can deliver on these things, then I think it’s been a successful year for the industry.

HomeCare: How about personally for you? Are there goals you have set?

Grau: I grew up in this industry, I started with the manufacturer Pride Mobility Products many, many years ago.

I really love this industry. First of all, you’re doing this incredible work: People get back to enjoying their lives and get out there with this equipment. That’s a big thing, and whenever there’s some frustration, you have to anchor yourself to why you’re doing this.

My real goal here is to leave the industry stronger in the future than it is today, and to ensure that complex rehab technology manufacturers are competing in a business-friendly environment … and drive the value
of CRT home for the consumer and the general public. That means ensuring we have inclusion of individuals utilizing equipment so they can lead their best life. That’s what it’s about.

HomeCare: Let’s dig into seat elevation. (See more on below about CMS’ decision to expand coverage for power seat elevation on certain power wheelchairs for Medicare beneficiaries.) The level of public comments was astounding.

Grau: We appreciate the work everyone is doing on this. NCART was a big part of it, as was the ITEM coalition based in Washington, D.C. All those groups that we talked about—providers, manufacturers, clinicians, academics, the assistive technology professionals (ATPs) and the consumers—I think CMS saw all of those comments and realized just how game-changing this product can be for a person utilizing this technology. And it’s got to be covered.

We’re very excited about it, but at the same point, we were disappointed that we didn’t see anything on our standing systems, but we’ll continue to work on that. And when CMS does open that up, we’re going to be ready.

HomeCare: It looks like there’s been a lot of progress happening at the state level. Can you talk about some next steps NCART is looking at?

Grau: We work with our members to identify areas where we’re seeing either funding or fee schedules not matching up with cost. Where is it an access issue? That’s one of the things we want to address.

We have, I think, five or six that we’re working on right now in different states to address those issues. We work with our members, we meet with the regulators, and in some cases, we may have to go the legislative route.

The main thing we’re pushing right now is we’re reaching out to Medicaid in all the states on the adjustment that was allotted by CMS for equipment repairs; it’s incredibly important that they implement these (consumer price increase) adjustments. It’s going to ensure that people can get the equipment they need and providers can continue to service, not only equipment, but also the large service areas. We just invested in a document from a disability attorney to identify which states are potentially in violation of rules about Medicaid.

HomeCare: You mentioned one of the priorities is the right to repair. Where does NCART stand on that? I assume you are working to bridge the gap between consumers and providers or bring them to a place of understanding.

Grau: We understand that people want to be able to repair their products. But I think a lot of people forget that our equipment is a (Food and Drug Administration) regulated product and there are thorough regulations, and we have to be very careful. Manufacturers and suppliers invest a huge amount to make sure their people are trained properly because the last thing everyone wants is to have somebody get hurt. That’s a big part of this. So, again, we’re deciding to approach it as reform rather than, ‘Hey, here’s one thing we’ll focus on.’ Let’s focus on service repair reform, let’s work with consumers to come up with solutions that are really going to fix the problem.

Now there’s certain things that we don’t control. Jobs—our guys are actively out there trying to hire more people. They have to be a little bit selective; the right tech has not only the right technical skills but also the right personality. They’re not ATPs, but we’ve got to be very cognizant of the individuals that we serve.

And we really want the service to be reimbursable. Not just the repairs, but also the travel. Sometimes a tech drives three hours to go see a person—that’s not funded. … Then they get there and they’ll spend sometimes hours diagnosing the problem and then on top of that you can’t fix it cause you’ve got to go back and get prior authorization.

Prevention and maintenance is another thing too that consumers really agree with and like. Let’s identify the issue before it causes major disruptions to their lives and fix it before it becomes an emergency. The consumers are very much behind that.

Those things are what’s important and that’s why we have to work together.

HomeCare: One of the things you’ve talked about is making sure payers and the public understand the work the industry does. How do you think we can change that perception or bridge that gap?

Grau: I think it’s the same issue we dealt with years ago. We have to continue to educate payers and the public on the training that goes into the people we work with, but also getting people to understand the process both on the business side and also what does it take to provide complex rehab to a patient? All the work that goes on behind the scenes. These products are not off-the-shelf products you can swap in and sell. … We need to let people know about that.

We also need to let them know that we have a five-year commitment to our customers.

They just think in a lot of cases we’re just dropping off the wheelchair. No, no, we’re not dropping off a wheelchair. We’re so much more than just equipment. They may have disease states to where we’re working to care for them and give them the ability to approach their life in whatever way they want.

A Win on Seat Elevation

The Centers for Medicare & Medicaid Services (CMS) announced May 16 that it would make power seat elevation for power wheelchairs eligible for reimbursement as durable medical equipment (DME) for the first time.

Seat elevation for Medicare-covered power chairs is now a clinically meaningful benefit for people with Medicare who perform transfers or use their chairs for mobility-related activities of daily living such as dressing, grooming, toileting, feeding and bathing. DME advocates, mobility manufacturers and members of the disability community had urged CMS to issue the Benefit Category Determination and National Coverage Decision, bringing in more than 5,000 public comments.

“This landmark Medicare decision to cover seat elevation is a major milestone that will improve the quality of life for so many who rely on this technology,” CMS Administrator Chiquita Brooks-LaSure said.

Advocates called the decision a win for wheelchair users and their caregivers.