New Mexico Approves Bill to Mandate CRT Coverage Consideration

NEW MEXICO—Gov. Michelle Lujan Grisham of New Mexico has signed a bill (HB 38) into law to mandate coverage consideration for complex rehab technology (CRT) wheelchairs for everyday use and for use for physical activities necessary to achieve or maintain the user’s health goals. 

“Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for prosthetic devices, custom orthotic devices and complex rehabilitation technology devices that is at least equivalent to that coverage currently provided by the federal Medicare program and no less favorable than the terms and conditions that the group health plan offers for medical and surgical benefits,” the bill reads.

The bill said a group health plan shall cover:

• The most appropriate prosthetic device or custom orthotic device determined to be medically necessary by the enrollee’s treating physician and associated medical providers to restore or maintain the ability to complete activities of daily living or essential job-related activities.
• A prosthetic device or a custom orthotic device determined by the enrollee’s provider to be the most appropriate model that meets the medical needs of the enrollee for performing physical activities, including running, biking and swimming, and to maximize the enrollee’s upper limb function.
• A prosthetic device or custom orthotic device determined by the enrollee’s prosthetic or orthotic care provider to be the most appropriate prosthetic device or custom orthotic device that meets the medical needs of the enrollee for purposes of showering or bathing.
   

The National Coalition of Assistive & Rehab Technology (NCART) said the legislation is the first of its kind to mandate coverage consideration for a CRT wheelchair for daily use as well as a CRT wheelchair for physical activities. 

“NCART greatly appreciated the opportunity to work with the “So Every BODY Can Move” initiative to secure access to prosthetics, custom orthotics and complex rehabilitation technologies in New Mexico,” NCART said. “HB 38 passed out of each committee and off the house and senate floors unanimously during the short legislative session and signed into law by the governor.”

NCART said the bill also put necessary protections in place for beneficiaries who require CRT by mandating the requirements of an accredited CRT supplier and ensures the beneficiary is evaluated by a licensed/certified medical professional prior to the prescript on a CRT manual or power wheelchair.