Ensuring Access via the CRT Act
A rehab supplier's view of why H.R. 942 and S. 948 are vitally important.
When gathering my thoughts on why protecting access to complex rehabilitation technology (CRT) is so important, I was forced to think about what caused a major change in our firm in the early 1980s. We transitioned from a pharmacy that provided medical supplies and durable medical equipment to a company with a defined division for also servicing rehab clients requiring customized seating and mobility devices.
Why? It was the epiphany that individuals needed to be positioned within wheelchairs (manual and power) for anatomical symmetry, function, respiration and digestion to address their medical needs and maximize independence. The wheelchair was only the base component.
I remember we began our road to positioning by fabricating all of our solid seats and inserts prior to the advent of manufacturer models. By giving the pelvis stability and preventing internal rotation of the knees, we saw immediate improvement in posture. Of course, we quickly recognized the need to position the spine, extremities, accommodate fixed curvatures and stabilize flexible deformities.
We were working with clinicians from rehab facilities (adult and pediatric) in the Pittsburgh area, physiatrists, PTs, OTs and speech therapists, who had limitless creative energy and goals for their patients. No two rehab clients presented in the same way. Every day, we solved a puzzle and it was exhilarating. We knew we were making a difference by stretching our scope and mastering innovative designs.
We recognized that our rehab division staff had to be very dedicated, educated and totally committed to meeting clinical goals for individuals of all ages with significantly involved medical conditions. RESNA- and NRRTS-led certification programs enhanced our ability to provide educated, credentialed assistance.
We became part of the creative technical team. We combined manufacturer products and many in-house, custom-fabricated items to help customers who required more than just a standard wheelchair and cushion. With each year, product improvements and innovation gave rehab suppliers like us the ability to meet clinical goals more effectively and enhance the quality of life for our clients.
Along the way, we fought for insurance coverage and payment. It took excellent communication skills; before-and-after photographs of positioning as visual evidence; and a tenacious approach to overturn denials. There was a lot of learning and hard work in addition to the substantial financial investment in inventory and staff. Rehab clients presented with more issues, more problems to solve and more challenges for our company. But it was worth the effort; by providing complex rehab equipment, we were helping clients achieve their goals.
Fast Forward to 2014
Fortunately for people who rely on CRT, the Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 942 and S. 948) has been introduced by Reps. Joe Crowley (D-N.Y.) and Jim Sensenbrenner, Jr. (R-Wis.) and Sens. Chuck Schumer (D-N.Y.) and Thad Cochran (R-Miss.). The bipartisan introduction into the House and Senate underscores that there are Medicare beneficiaries who require much more from their equipment than the standard items. The legislation points to the need for enhanced supplier credentialing and expertise to earn the right to provide the products. It builds on the competitive bidding exemption of Group 3 power wheelchairs and accessories to include other individually configured products specifically applicable to rehab clients.
The CRT legislation speaks to the many individuals with diagnoses, such as cerebral palsy, muscular dystrophy, multiple sclerosis and spinal cord injuries among others, facing physical and functional challenges for life. It speaks to the many individuals that require unique equipment to achieve total functionality and quality of life. It speaks to the need for creation of a separate benefit category within the Medicare program for these specific products, protecting beneficiary access for people with disabilities for the long-term.
It also specifies safeguards. To help control fraud and abuse, the legislation would establish clinical conditions for coverage ensuring appropriate prescription; a mandated evaluation by a licensed PT or OT with no financial relationship to the supplier; and additional accreditation for suppliers demonstrating they are compliant with the additional quality standards, protecting patient outcomes.
Operationally, it would separate out billing codes for items classified as CRT and create new billing codes for CRT items currently included in broader codes. For any new billing codes, the Secretary of Health and Human Services would establish a new payment system, taking into account the unique needs of beneficiaries who require CRT items and the resources and staff needed to provide appropriate customization of CRT items. New payment rules and policies would be developed.
H.R. 942 and S. 948 would also improve program safeguards by increasing quality standards for suppliers of CRT items above the current DME standards, including that each supplier must have qualified staff available to assist beneficiaries with training and repair for their CRT items. CRT suppliers would also require accreditation by an independent accreditation organization demonstrating they are compliant with the enhanced quality standards.
Importantly, CRT items would be exempt from Medicare’s “in the home” restriction which, as we know, does not address a beneficiary’s needs outside the home environment. In addition, beneficiaries residing in skilled nursing facilities would be permitted to obtain CRT if these items are part of a plan of care allowing them to transition from the skilled nursing facility to home and community.
Through the CRT legislation, access to specialized wheelchairs, seating and positioning systems and other adaptive equipment for a person with a disability is protected for the long-term.
For those of us who are deeply committed to providing quality products and specialized services to the rehab client, it fortifies our ability to continue to do so.
Developed through the concerted effort of the National Coalition for Assistive and Rehab Technology and supported by The American Association for Homecare and more than 50 national, consumer and clinician advocacy organizations, this bill will become legislation if we all educate our lawmakers. It provides long-term positive benefits for beneficiaries and long-term savings to the program by ensuring quality products, quality suppliers and quality outcomes.
As I write this, 150 Representatives and 20 Senators have signed on to H.R. 942 and S. 948 respectively. Let’s all rally to get H.R. 942 and S. 948 passed! Please do your part by working to get your members of Congress signed on now. For an up-to-date listing of co-sponsors and tools that you can use, please visit www.access2crt.org.
This article originally appeared in the October 2014 issue of HME Business.
About the Author
Georgie Blackburn is vice president of Government Relations and Legislative Affairs for Pennsylvania-based provider BLACKBURN’S. She can be reached at firstname.lastname@example.org.