Many of you have inquired as to what we will be doing in Washington, D.C. this week with Willy. Let me try to explain.
We have been invited to attend the National Certified Rehabilitation Technology (CRT) Leadership and Advocacy Conference (http://www.ncart.us/crtconference/) by Chris Savoie who is the wheelchair guru at University of Michigan's Wheelchair Seating Department. He has been fitting Willy for his devices since he was three. (Since Willy was three, not Chris. Chris isn't THAT good.)
 |
| Willy being introduced to his new big boy wheelchair by Chris Savoie, U of M Wheelchair Seating (on the right.) State Representative Mike Simpson looks on along with one of Willy's therapists from Lyle Torrant Center. |
Some Basic Information:
What is Certified Rehabilitation Technology?
CRT is medically necessary and individually configured wheelchairs, adaptive seating and positioning systems, standers, gait trainers, and other equipment that requires evaluation, configuring, fitting, adjustment, training, and programming.
 |
| Willy in a standing device at Haisley Elementary, Ann Arbor, MI |
CRT is provided through an interdisciplinary clinical and technology team that includes at a minimum a physician, therapist, and certified rehab technician. CRT is designed to meet the individual's specific and unique medical, physical, and functional needs.
Of all the manual wheelchairs Medicare pays for, 6% are CRT and 94% are standard. Likewise, 22% of the power wheelchairs Medicare pays for are CRT and 78% are standard. Complex manual and power wheelchairs are intended for long-term use. They come with high adjustability, provide positioning, they accommodate orthopedic issues and provide pressure management. They can come with advanced electronic controls and offer ventilator accommodation. They are NOT the wheelchairs or "scooters" you see advertised on television.
In comparison, "standard" wheelchairs are intended for short-term use and have zero to minimal adjustability. They do not provide positioning, orthopedic accommodations, or pressure management. Think of the wheelchairs that you can borrow at the zoo for your elderly grandmother because she can't walk that far. CRT is NOT that. Willy would fall right out of one of those!
Bottom line: These items are the legs and arms of people with severe multiple disabilities including neurological disorders and traumatic brain injuries and the only way they can maneuver through life.
What are our Goals at this Conference?
There are over 170 attendees making visits to Congress consisting of consumer advocates (us,) and industry professionals. We have over 220 Congressional visits scheduled. We will be seeking to protect and improve access to CRT. We have two "asks:"
- To protect and improve access to CRT by co-sponsoring and passing Separate Benefit Category (SBC) legislation. Congress must pass this bill to improve coverage, safeguards, and access to CRT. Access to CRT is threatened because its differences are not recognized. Changes are needed (coding, coverage, payment) to fully recognize the specialized nature of CRT and the medical and functional needs of the individuals who rely on it. A SBC will improve and protect access within Medicare and then flow to Medicaid and other payers including other insurance policies and the ACA.
- To stop competitive bid pricing to CRT: CMS has announced that effective 1/1/16 it will apply competitive bid pricing which will result in 20-50% reduction in access to CRT for those who desperately need it. This is against congressional intent/legislation and Congress must intervene and get CMS (Center for Medicare Services) to rescind this policy change.
What is the History of the SBC Initiative
The work with this initiative began in September of 2009 with a steering group committee, consultants, and work groups. Two years were spent soliciting input and advice, developing detailed proposals, and creating supportive information and tools, Broad stakeholder engagement and support from consumers, clinicians, suppliers, and manufacturers allowed the initiative to gather broad bi-partisan support from early on. Legislation from Congress is required first for SBC, along with regulatory work with CMS.
Legislation Details
- Creates a separate category for CRT within the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) benefit (similar to O&P.)
- Recognizes specific codes as CRT and allows creation of new CRT codes as needed
- Eliminates the in-home restriction for CRT and adds functional considerations
- Allows nursing home residents to access CRT as part of the move to community residence
- Expands clinical evaluation for CRT mobility
- Increases supplier standards regarding credentialed staff and repair capabilities
- Exempts remaining CRT from competitive bidding
Support
- ITEM Coalition
- United Spinal Association
- ALS Association
- American Association of People with Disabilities
- National Multiple Sclerosis Society
- National Council on Independent Living
- Paralyzed Veterans of America
- Christopher and Dana Reeve Foundation
- American Occupational Therapy Association
- American Physical Therapy Association
- RESNA
- Clinician Task Force
- American Academy for Cerebral Palsy and Developmental Medicine
- American Academy of Physical Medicine and Rehabilitation
- American Congress of Rehabilitative Medicine
- Reaching for the Stars
- And More!
Congressional Support
- Last session 190 members had signed on
- Prior Bills:
- H.R. 942 had 168 Representatives
- 65 Republicans and 103 Democrats
- 22 on Ways & Means; 17 on Energy & Commerce
- S. 948 had 22 Senators
- 16 Democrats and 6 Republicans
- 5 on Finance; 4 on HELP
- This is a new Congress so we have more work to do
Message to Congress
- CRT is critical to the health and independence of people with complex disabilities
- CRT is specialized and individually configured like Orthotics & Prosthetics (custom braces/artificial limbs)
- These products and services are very different than standard DME and need segregation
- Broad DME policies and codes do not address people with disabilities
- H.R. 1516 and the new and yet unnumbered Senate bill must be passed to provide needed distinction and improvements
Cost of this Legislation
- A Washington DC actuarial form (Dobson & DaVanzo) was hired to estimate the cost
- Congressional estimates are typically made based on a 10-year projection
- The cost of the bill is estimated at $5 million per year over 10 years. (Pocket Change.)
- Does not include the impact of savings from improved access to CRT
- We will need Congressional Budget Office (CBO) to do "official" scoring
CRT Educational Sites
http://www.ncart.us/
http://www.access2crt.org/
http://www.cms.gov/
http://www.nrrts.org/
What Can You Do?
This is a very important question. Most of you thankfully do not have any idea of what goes on in this medically fragile and complex world that we live in. But we need your help. Please contact your State Senators and ask them to sign onto the Access to Complex Rehab Technology bill that will soon be introduced in the Senate by Senators Schumer and Cochran. Also, please contact your Representative and ask him/her to sign onto HR 1516 that was a bi-partisan introduction into the House.
If you want to know if your Representative or Senator has already signed on for support, please go to this site: http://www.access2crt.org/
Our Personal Experience with CRT Problems
Last but not least, let me tell you our story. William was about 4 when he grew out of his first wheelchair which was called a "Kid Cart." Our physiatrist had sent a prescription referral to University of Michigan's Wheelchair Seating to order a new wheelchair. One that would grow with him and that would better protect his body. Of course it was denied several times by our insurance company, Priority Health. At the time, my then-husband was gainfully employed by the State of Michigan and we thought we had great insurance.
After months of denials and a few growth spurts, we desperately needed Willy's new chair. His hips were actually being squeezed in by his old chair and it was causing permanent damage to his body. It was painful for him to sit in his chair yet we had no other way to transport him or take him anywhere.
After hundreds of frustrating phone calls to U of M's Wheelchair Seating and Priority Health, we finally got our State Representative, Mike Simpson, involved. He helped us launch a media campaign that "coerced" Priority Health to authorize the new chair. Priority Health paid an initial small deposit on the new wheelchair but the balance was never paid and went on our credit report where it still lives today. It took a total of about 14 months to get the new wheelchair approved and delivered.
We must protect and improve access to CRT.
