New Challenges in Complex Rehab Technology

As we move through 2021, the impact and consequences of the COVID-19 pandemic are still significant factors in the provision of complex rehab technology (CRT) to people with disabilities. Thankfully, the policy changes put in place in 2020 to help ensure continued access remain in place and will be maintained through the end of the public health emergency (PHE).

While it is hard to predict what lies ahead, the Department of Health and Human Services (HHS) has formally extended the PHE declaration and indicated that the PHE will likely remain in place until the end of 2021. HHS has also indicated that it would provide 60 days’ notice prior to terminating the PHE or allowing it to expire. Accordingly, the emergency provisions that are in effect should remain in place to the end of 2021— and potentially longer.

While the year ahead holds uncertainty, when it comes to CRT issues and advocacy, there is a full plate of initiatives underway to protect and improve access. Here are some of the priorities.

1. Stop July 1 cuts to CRT manual wheelchair accessories.

The prospect of July 1 Medicare payment cuts to CRT manual wheelchair accessories looms as a threat to reduce access for individuals with disabilities who depend on these specialized mobility systems.

The National Coalition for Assistive and Rehab Technology (NCART) is continuing to urge the Centers for Medicare & Medicaid Services (CMS) to “make permanent” the congressionally mandated 18-month suspension that stopped CMS from inappropriately using Medicare competitive bid program payment rates for standard durable medical equipment (DME) items to set payment rates for the more specialized items used with CRT manual wheelchairs. To make this suspension permanent, CMS must take action before June 30.

NCART and other CRT industry stakeholders have provided analysis and recommendations to CMS as to the pathway to implementing a permanent policy change. Unfortunately, CMS has yet to come to a decision on whether or when it will take the necessary action. This process has been complicated by the change in administration and the delays in seating the new HHS secretary and CMS administrator.

Industry groups are in discussions with congressional champions regarding reaching out to newly appointed HHS Secretary Xavier Becerra to urge CMS to prioritize making the current policy permanent, just as CMS did in 2017 for CRT power wheelchair accessories.

2. Prevent Medicaid payment cuts to CRT.

The potential of Medicaid payment cuts was identified as a 2021 risk to CRT access given the financial impact that the COVID-19 pandemic was projected to have on state budgets. Accordingly, NCART has been monitoring state budget announcements and working with state associations and other stakeholders to minimize this threat.

To strengthen these efforts, NCART has developed a “No Cuts to CRT” toolkit for communicating with state legislatures and health departments. The toolkit includes a position paper with key CRT talking points, infographics with state Medicaid information, a summary of the CRT delivery process, and other information supporting the need to protect CRT from rate reductions that would reduce access. For more details, email Mickae Lee at [email protected].

3. Get coverage for power seat elevation & standing systems.

The work of the work group led by the Independence Through Enhancement of Medicare And Medicaid (ITEM) Coalition continues regarding the formal request to CMS for Medicare coverage of power seat elevation and standing systems. NCART’s collaboration with the ITEM Coalition remains in place as consumer, clinician and industry stakeholders continue the process of securing long-overdue coverage for this medically necessary equipment.

The ITEM workgroup recently met with Lee A. Fleisher, Medicare’s chief medical officer, and provided an overview of the application for coverage and the clinical evidence and support of the medical necessity and benefit of these systems for individuals with disabilities.

It is expected that CMS will be announcing soon that the National Coverage Determination (NCD) has been formerly opened for reconsideration. Upon this notice, there will be a 30-day public comment period, during which organizations and individuals can respond to CMS in support of establishing Medicare coverage.

In addition to encouraging the submission of supportive public comments, the work ahead will involve further dialogue with the CMS review team and responding to questions or requests for additional information.

4. Establish permanent CRT telehealth services.

While current COVID-19 telehealth policies will remain in effect through the end of the PHE, there is a need for telehealth to be remain available as a permanent option. For this to happen, congressional and CMS actions will be required.

Telehealth has been generating much discussion in the new session of Congress. Of particular significance, in March the House of Representative’s Committee on Energy and Commerce’s Subcommittee on Health held a four-hour hearing called “The Future of Telehealth: How COVID-19 Is Changing the Delivery of Virtual Care.” The hearing presented a robust discussion from committee members and invited witnesses to talk about needs, pathways and concerns regarding making telehealth options permanent beyond the PHE.

Of special importance to the provision of CRT, the “Expanded Telehealth Access Act” (HR 2168) has been introduced in the House of Representatives by Reps. Mikie Sherill (D-N.J.) and David McKinley (R-W.V.). HR 2168 contains important provisions to expand access to telehealth services and specifically adds physical and occupational therapists as permanently authorized telehealth practitioners within the
Medicare program.

It is important that these clinicians be designated as authorized telehealth practitioners after the end of the PHE so they can continue to provide services and care to their clients with disabilities who require CRT and may not be able to get to a clinic or to be seen in-person for needed evaluations and follow up. The legislation also includes speech language pathologists.

NCART and other CRT stakeholders continue to meet with congressional staff to discuss the benefits of telehealth for individuals using CRT and requesting that any final congressional legislation include language directing CMS to include physical therapists and occupational therapists as permanent authorized telehealth practitioners.

CRT stakeholders should contact their members of Congress requesting action to support telehealth and CRT access. People can visit protectmymobility.org and use the links to email their members asking for passage of HR 2168.