Members of Congress Urge CMS to Reform CRT Access

WASHINGTON—Two homecare leaders in the U.S. House, along with other members of congres, have written to the Centers for Medicare & Medicare Services (CMS) to say that there are significant gaps in Medicare’s coverage and reimbursement framework for complex rehabilitation technology (CRT)—including customized power wheelchair system —for beneficiaries living with physical and functional disabilities.

In a letter to CMS Administrator Mehmet Oz, U.S. Representatives Debbie Dingell, Brian Fitzpatrick and colleagues highlighted CMS’s responsibility to the tens of thousands of Medicare beneficiaries each year who depend on complex rehabilitation technology (CRT) to maintain their mobility and independence. The lawmakers encouraged prioritizing these reforms and maintaining an open discussion between offices.

“Under current rules governing Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) benefit for CRT equipment, a component part must have already failed or malfunctioned before Medicare will cover any servicing of the equipment—meaning that routine, scheduled maintenance designed to prevent failure is categorically excluded from reimbursement. This framework is counterproductive in two respects. First, it drives avoidable equipment failures: Problems that could be identified and corrected through routine maintenance instead go unaddressed until they become acute. Second, it undermines beneficiaries’ ability to plan,” the lawmakers wrote.

A second and related problem, they said, centers on the fact that Medicare’s coverage of repairs to customized power CRT equipment is conditioned on the beneficiary having a valid prescription on file dated within the prior twelve months.

“For beneficiaries who depend on power wheelchairs and similar equipment, this requirement creates an unnecessary and potentially harmful administrative obstacle,” they added.

They urged CMS to address both issues through regulatory action.

“Each year, tens of thousands of Medicare beneficiaries depend on CRT systems and equipment to maintain their mobility and independence,” they said. “Removing the prescription renewal barrier and providing coverage for preventative maintenance of CR equipment are targeted, achievable steps that would meaningfully improve care for this vulnerable population. We encourage CMS to prioritize both reforms and welcome the opportunity to discuss them further.”