Complex Rehab Technology

Transcription

1 Complex Rehab Technology Specialized wheelchairs, seating and positioning systems, and other adaptive equipment used by people with significant disabilities and chronic medical conditions

2 Congressmen Crowley and Sensenbrenner Announce Legislation to Improve Access to Complex Rehabilitation Technology for Medicare Patients March 7, 2013 (Washington, D.C.) Today, Reps. Joe Crowley (NY 14) and Jim Sensenbrenner (WI 5) announced the reintroduction of the Ensuring Access to Quality Complex Rehabilitation Technology Act (H.R. 942), legislation that helps ensure patients with disabilities or severe medical conditions are able to access the highly specialized medical equipment that meets their needs and helps improve their day to day lives. Specifically, the bill establishes a distinct Medicare benefit category for complex rehabilitation technology products (CRT), such as specialized power wheelchairs and adaptive seating systems. This would allow the Centers for Medicare & Medicaid Services (CMS) to better target their payment and coverage policies to this unique type of equipment, by adopting higher quality standards for suppliers, improving oversight to prevent fraud and abuse, and expanding eligibility criteria for beneficiaries to access these products. For people with disabilities or other medical conditions, complex rehabilitation technology products aren t a luxury, they re a necessity, said Rep. Crowley. Our legislation will help ensure more patients can access the high quality products and services they need to help them lead a better, more independent life. And, it puts forward much needed quality standards and consumer protections, making the Medicare program stronger for individuals and suppliers as a result. As someone who has been a leader in the past, fighting for the rights of the disabled, I want to ensure that all Americans have full access to the best tools available, giving them the ability to live each day to the fullest, said Rep. Sensenbrenner. Disabled Americans should not be denied the benefits of proper rehabilitation or medical equipment that can provide them the opportunity to live and work freely and independently. With increased flexibility and proper oversight, we can ensure help for those in need while inhibiting fraud and abuse. Currently, the Medicare program includes CRT products in the same category as standard durable medical equipment, like traditional manual wheelchairs, which limits access and product choice, as individuals that use CRT products differ from the traditional Medicare population. These individuals experience physical, functional and cognitive challenges every day as a result of significant disabilities or medical conditions, such as cerebral palsy, muscular dystrophy, multiple sclerosis, and spinal cord injuries. Grouping CRT products with other durable medical equipment doesn t allow CMS the flexibility to address the distinctive needs of the individuals that use these products or the suppliers that assist them. Furthermore, these complex and often customizable CRT products require a broader range of services and specialized personnel, as well as much more training and education for suppliers to ensure appropriate use. Congress has previously recognized unique situations like this one by creating a separate benefit category for orthotics and prosthetics, another highly specialized medical equipment category, which has its own medical policies, accreditation standards, and payment calculations. In addition, the bill includes provisions to ensure these items are being prescribed appropriately to prevent fraud and abuse, including requiring that a licensed physical or occupational therapist evaluate the patient, increased quality standards for suppliers of these products, and a supplier accreditation process to ensure compliance with these enhanced quality standards. The bill will also remove barriers that beneficiaries currently face in obtaining this equipment; for example, by making it easier for patients in skilled nursing facilities to transition to home or community care. The Ensuring Access to Quality Complex Rehabilitation Technology Act is supported by multiple patient, medical professional and supplier organizations, including: American Association for Homecare, American Physical Therapy Association, Brain Injury Association of America, Christopher and Dana Reeve Foundation, Easter Seals, National Association for Home Care & Hospice, National Coalition for Assistive and Rehab Technology, National Multiple Sclerosis Society, Paralyzed Veterans of America, and United Spinal Association. "I am so happy that Representatives Crowley and Sensenbrenner have reintroduced this important bill, H.R. 942, Ensuring Access To Quality Complex Rehabilitation Technology Act of 2013, which creates a separate benefit under Medicare for customized wheelchairs that will ensure our members with spinal cord injury and disorders living with significant disabilities such as multiple sclerosis, spina bifida or amyotrophic lateral sclerosis (Lou Gehrig's disease) obtain the medical equipment they need to live independent, fully functioning lives, as is their right, said Paul Tobin, President and CEO of the United Spinal Association, a nationally recognized organization based in Queens, N.Y. that works to improve the quality of life of all people living with a spinal cord injury or disease. ****************************************

3 POSITION PAPER Congress Must Pass H.R. 942 Protect People with Disabilities Access to Complex Rehab Technology Position A separate benefit category for Complex Rehab Technology (CRT) must be established within the Medicare program so that continued access to this critical technology and related services can be assured. These specialized products are currently included within Medicare s broad durable medical equipment (DME) benefit category which does not provide adequate differentiation of CRT devices and prevents focused policies and safeguards. A separate benefit category for CRT will provide appropriate segregation to better address the unique needs of individuals with disabilities and chronic medical conditions who require these specialized products. This will allow for needed improvements in coverage policies, coding, and quality standards. Background The DME benefit was created over forty years ago to address the medical equipment needs of elderly individuals. Over the years available technology has advanced to now include highly configurable manual wheelchairs, specialized power wheelchairs (not the wheelchairs you see on TV), adaptive seating and positioning systems, and other specialized equipment such as standing frames and gait trainers. This technology called Complex Rehab Technology is prescribed and customized to meet the specific medical and functional needs of individuals with disabilities and chronic medical conditions. These highly specialized products and services are unique and significantly different from standard DME. Without a proper segregation of CRT, access is threatened because of its inclusion in Medicare s outdated durable medical equipment coverage and classification system. Current Medicare policies do not adequately address the needs of individuals with disabilities, acknowledge the full range of services furnished by CRT companies, or incorporate the complexity and unique nature of the equipment itself. The implications of continuing to include CRT within the traditional durable medical equipment category are stark. Product choice will be limited and critical services will be curtailed. A full range of services may be unavailable to the individual with a disability, jeopardizing access to the most appropriate equipment and the necessary supportive services. Complex Rehab Technology Is Significantly Different From Standard DME Population Served: Complex Rehab Technology is used by individuals with significant disabilities and medical conditions different from those of the traditional elderly Medicare population. The CRT population, who tend to qualify for Medicare based on their disability and not their age, consists of individuals with diagnoses that include, but are not limited to, cerebral palsy, muscular dystrophy, multiple sclerosis, spinal cord injury, amyotrophic lateral sclerosis (Lou Gehrig s disease), and spina bifida. Complex Rehab Technology Services: Complex Rehab Technology requires a broader range of services and specialized personnel than what is required for standard DME. The provision of CRT is conducted through an interdisciplinary team (referred to as the CRT Team) consisting of, at a minimum, a physician, a physical therapist or occupational therapist, and a rehab technology professional (RTP). Devices in this category require a technology assessment completed by a certified RTP employed by a CRT company. This assessment

4 involves matching the medical and functional needs of the individual with appropriate products. Simulations or equipment trials are often used to ensure that the items are appropriate and meet the individual s identified needs. Because the equipment is complex and becomes an extension of the person, fitting, training, and education requires more time than standard DME items. In addition, Medicare requires environmental assessments within the home for certain CRT products. Uniqueness of Complex Rehab Technology Devices: Many of the products require a physical evaluation, a technology assessment, measuring, fitting, simulations and trials, a mixing and matching of products from different manufacturers, significant training and education, and refitting and ongoing additional modifications. Specialized Staff: The Medicare program requires that CRT companies employ specialized and credentialed staff to analyze the needs of individuals with disabilities and assist in the selection of the appropriate equipment. These credentialed personnel, called Assistive Technology Professionals (ATP), are certified by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) and specialize in the assessment, selection, and provision of CRT products. More Comprehensive Quality Standards: The Medicare program has established quality standards that all DME companies must meet to qualify for participation in the Medicare program. The Centers for Medicare and Medicaid Services (CMS) has included additional and more rigorous quality standards with which CRT companies must comply. Congressional Precedents for Treating Customized Devices Differently Congress has acknowledged complex rehab power wheelchairs are unique and more specialized than standard DME. In 2008 it passed legislation exempting these products from inclusion in Medicare s DME competitive bidding program recognizing that such inclusion would jeopardize access to this customized technology. In addition, Congress has recognized the unique nature of other customized products and services and created a separate classification for Orthotics and Prosthetics (O&P), i.e. custom braces and artificial limbs. CMS acknowledged the specialized service component inherent in custom fit orthotics and prosthetics and treats O&P as separate and unique with its own medical policies, accreditation standards, and reimbursement calculations. This same distinct recognition is needed for Complex Rehab Technology. Recommendation Congress must pass the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 (H.R. 942) to establish a separate benefit category for CRT products and services within the Medicare program. This will appropriately recognize the customized nature of CRT and make other required changes to better address the unique needs of individuals with disabilities and chronic medical conditions who require these specialized products and related services. A summary of the legislation, a listing of supportive national consumer and medical professional groups, and other materials can be found at This initiative is led by the National Coalition for Assistive & Rehab Technology (NCART), the American Association for Homecare (AAH), the National Registry of Rehabilitation Technology Suppliers (NRRTS), the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), the Clinician Task Force (CTF), the United Spinal Association (USA), and the Independence Through Enhancement of Medicare and Medicaid Coalition (ITEM). Contact Don Clayback, Steering Committee Chair, at or dclayback@ncart.us for more information.

5 2012 CRT Legislation Co Sponsors H.R "Ensuring Access To Quality Complex Rehabilitation Technology Act of 2012" House Members Signed On In 2012 (By State) State Member Party Medicare Committee Term 1 CA 5 Doris Matsui D Energy & Commerce 4 2 CA 16 Rep. Zoe Lofgren D 9 3 CA 22 Rep. Devin Nunes R Ways & Means 5 4 CA 39 Rep. Linda Sánchez D 5 5 CO 2 Rep. Jared Polis D 2 6 CT 1 Rep. John Larson D Ways & Means 7 7 CT 2 Rep. Joe Courtney D 3 8 FL 10 Rep. Bill Young ** R 21 9 FL 15 Rep. Bill Posey R 2 10 FL 19 Rep. Ted Deutch ** D 2 11 FL 23 Rep. Alcee Hastings D GA 4 Rep. Hank Johnson D 3 13 GA 5 Rep. John Lewis D Ways & Means GA 12 Rep. John Barrow D Energy & Commerce 4 15 IA 1 Rep. Bruce Braley ** D 3 16 IA 3 Rep. Tom Latham R 9 17 IL 12 Rep. Jerry Costello D MA 2 Rep. Richard Neal D Ways & Means MD 2 Rep. Dutch Ruppersberger D 5 20 MD 7 Rep. Elijah Cummings D 9 21 ME 1 Rep. Chellie Pingree D 2 22 ME 2 Rep. Michael Michaud D 5 23 MN 7 Rep. Collin Peterson D MS 3 Rep. Gregg Harper R Energy & Commerce 2 25 NY 1 Rep. Timothy Bishop D 5 26 NY 7 Rep. Joseph Crowley (Sponsor) D Ways & Means 7 27 NY 8 Rep. Jerrold Nadler ** D NY 15 Rep. Charles Rangel ** D Ways & Means NY 20 Rep. Chris Gibson R 1 30 NY 22 Rep. Maurice Hinchey ** D NY 28 Rep. Louise Slaughter ** D RI 1 Rep. David Cicilline ** D 1 33 RI 2 Rep. James Langevin ** D 6 34 TN 6 Rep. Diane Black R Ways & Means 1 35 VA 8 Rep. James Moran D VA 11 Rep. Gerald Connolly D 2 37 WA 4 Rep. Doc Hastings R 9 38 WA 5 Rep. Cathy McMorris Rodgers ** R Energy & Commerce 4 39 WI 4 Rep. Gwenn Moore D 4 ** Member of House Bipartisan Disabilities Caucus

6 Organizations Supportive of H.R. 942 Ensuring Access to Quality Complex Rehabilitation Technology Act of ) ACCSES 2.) ALS Association 3.) American Academy of Physical Medicine and Rehabilitation 4.) American Association for Homecare 5.) American Association of People with Disabilities 6.) American Congress of Rehabilitation Medicine 7.) American Medical Rehabilitation Providers Association 8.) American Music Therapy Association 9.) American Occupational Therapy Association 10.) American Physical Therapy Association 11.) American Therapeutic Recreation Association 12.) Association of Assistive Technology Act Programs 13.) Association of University Centers on Disabilities 14.) Blinded Veterans Association 15.) Brain Injury Association of America 16.) Christopher and Dana Reeve Foundation 17.) Clinician Task Force 18.) Disability Health Access, LLC 19.) Easter Seals 20.) Harris Family Center for Disability and Health Policy 21.) Hearing Loss Association of America 22.) Helen Keller National Center for Deaf Blind Youths and Adults 23.) ITEM Coalition 24.) National Association for Home Care & Hospice 25.) National Coalition for Assistive and Rehab Technology 26.) National Council on Independent Living 27.) National Family Caregivers Association 28.) National Multiple Sclerosis Society 29.) National Registry of Rehabilitation Technology Suppliers 30.) National Rehabilitation Hospital 31.) National Spinal Cord Injury Association 32.) Paralyzed Veterans of America 33.) Rehabilitation Engineering and Assistive Technology Society of North America 34.) Spina Bifida Association 35.) TASH 36.) The Arc of the United States 37.) United Cerebral Palsy Association 38.) United Spinal Association 39.) Unite 2 Fight Paralysis 40.) VetsFirst

7 Call to Action for Complex Rehab Technology Congress Needs To Pass Legislation (H.R. 942) To Protect Access To Specialized Wheelchairs, Seating Systems, Other Adaptive Equipment Legislation has been introduced in Congress to protect and improve access to specialized wheelchairs, seating and positioning systems, and other adaptive equipment used by people with significant disabilities and chronic medical conditions. These products are referred to as Complex Rehab Technology (CRT). The legislation is entitled the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 and has been assigned bill number H.R The bill will create a Separate Benefit Category for CRT within the Medicare program (similar to the separate category given to Orthotics and Prosthetics) and provide needed changes and safeguards to improve access for people with disabilities who rely on this specialized equipment and the related supporting services. To provide advocacy tools and background information a central website has been created at Here you will find a variety of resources to help get H.R. 942 passed: Introduction to CRT video (10 minutes) share this link with Congress and others to educate them on what CRT is, who uses it, why it s important, and how it s provided. Contact Congress link this link allows you to enter your zip code and your Representative and both Senators requesting them to support H.R For best results personalize the suggested message from your own perspective. National Petition link after sending your s, you can also sign the electronic petition that will be shared with Congress to show widespread support for the bill. Educational Material view and share the summary of H.R. 942, the position paper, the list of supporting national organizations, and other educational documents. Getting legislation passed in Congress is a real challenge. H.R. 942 will only get passed if enough Members hear from stakeholders in their home districts and states. We need thousands of people from across the country to contact Congress and tell them this issue is important and they need to sign on to this bill! Here is your call to action: Step 1 Go to Step 2 your Members of Congress and sign the National Petition Step 3 Spread the word and get others engaged in this advocacy Step 4 Follow up with your Members until they sign on to H.R. 942 With everyone s help we can get H.R. 942 passed and protect access to Specialized Wheelchairs, Seating Systems, and Other Adaptive Equipment!