My wheelchair is considered “CRT” because it meets my specific needs. Since it is one of a kind, it can be difficult to prove that it is medically necessary. I’ve experienced countless denials from insurance companies and The Centers for Medicare and Medicaid Services (CMS). My struggles with CMS are not unique. On behalf of clients like myself, Custom Mobility regularly attends the National Coalition for Assistive and Rehab Technology (NCART) Leadership and Advocacy Conference. This event is extremely important because it provides a platform for us to speak with State Representatives about improving access to CRT.
NCART is a national association that advocates for our rights to CRT. To support the population of CRT users, they arrange for us to meet with our local representatives on Capitol Hill. As I speak with Congressional and Senate staff, I begin to tell my story. I bring my seat to the floor and explain that I use it to reach my work and home computers. I describe how it allows me to reach a table so that I can feed myself and write. I explain the health benefits of the seating system, describing that it allows me to safely transfer onto the floor or other surfaces. Through my stories, and examples from other CRT users, we show the complexity of our equipment. The reality is, though it is quite expensive, it is vitally important to our quality of life. Furthermore, the cost of CRT makes up less than 1% of the total budget for Durable Medical Equipment (DME), and is integral to the lives of people with disabilities.
Wheelchair “accessories,” a term created by CMS, refers to the custom, essential components of a wheelchair. Without these modifications, our wheelchairs would be useless to us. These critical components include: pressure-relieving cushions, specialty controls, custom-made seat backs, adjustable head supports, etc. Without my seat cushion or seat back, my skin would break down, which could lead to pressure sores, further health complications, and possibly death. Without specialty controls, most of us couldn’t propel our wheelchairs, be independent, and maintain a job. Each of these devices serves an essential purpose. If even one component is removed, our independence and health is immediately put at risk.
Many people with disabilities are recipients of either Medicare or Medicaid. Since it is considered to be “medically necessary,” and despite its high cost, these entities cover the cost of CRT. Though there are additional, funding sources, such as insurance companies, NCART focuses its attention on CMS. Our efforts target Medicare and Medicaid because their policies are considered to be the industry “standard.” TRICARE is even affected, which provides our veterans with medically necessary equipment, such as CRT. Because TRICARE adopts CMS policies, our veterans could lose access to the equipment that they need and deserve.
Determining the appropriate equipment takes the specialized skills of therapists and clinicians. To assure that our needs are met, these medical professionals go through a process of evaluating, configuring, fitting, adjusting, and programming. Such procedures are ultimately factored into the final cost of CRT.
CMS creates the standard for the coverage of CRT, and their policies are adopted by other entities, such as insurance companies and TRICARE. And since TRICARE adopts them, our veterans could lose access to the equipment that they need and deserve. NCART’s goal is to exempt CRT Manual Wheelchair Accessories from the Medicare Competitive Bidding Program. When purchasing a new piece of CRT, Competitive Bidding requires CMS to bid on multiple quotes, offered by different providers of CRT. This means that CMS may not cover the cost of a wheelchair user’s critical components. While this approach allows CMS to save money, it puts many in jeopardy of losing the equipment that they rely on to lead a meaningful life.
My wheelchair is an incredible piece of technology. It is a sacred space that acts as my lifeline to the world. Without it, there are a multitude of goals that I never would have achieved, including: graduating with a Master’s degree, finding and maintaining a meaningful job, and forming lasting relationships. Like myself, there are a number of individuals who rely on CRT to lead happy, healthy, and productive lives. Though our well being is in jeopardy, H.R. 2293, the “Protecting Access to Complex Rehab Wheelchairs Act,” could provide some much needed relief.
How can you help? H.R. 2293 offers the most practical solution: “This bill will permanently exempt Complex Rehab Manual Wheelchairs from the Medicare Competitive Bidding Program and will also stop Medicare from applying Competitive Bidding payment rates to critical components (accessories) of Complex Rehab Manual Wheelchairs for 18 months. This suspension will allow time to develop a permanent policy change.”
In theory, Competitive Bidding can be quite useful when applied to general health solutions. However, regarding CRT, it won’t remedy the current issues faced by people with unique challenges. So, it is imperative that we amend its function within this context to provide Americans with disabilities the best possible healthcare.
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