A Reward for Persistence: CRT Advocacy Scores A Big Win

They say good things come to those who wait. While that’s often true, those who have been on the front lines pursuing protections for Complex Rehab Technology (CRT) wheelchairs understand that good things come to those who work persistently while they wait. Good things come to those who don’t quit. And good things come to those who won’t take “no” for an answer when there are big things at stake, like access to CRT for people with disabilities.

The CRT community proved the above in December 2019, when at long last we secured a Congressional victory with the signing of H.R. 1865, a year-end funding bill, that included language protecting access to CRT manual wheelchairs, accessories, and seating. This language came from two smaller bills that had been the focus of CRT advocacy for three years. H.R. 2293, introduced by Reps. John Larson (D-Conn.) and Lee Zeldin (R-N.Y.), and S. 1223, introduced by Senators Bob Casey (D-Pa.) and Rob Portman (R-Ohio).

H.R. 1865 includes two CRT provisions. The first provides a permanent exemption from the Medicare Competitive Bidding Program (CBP) for complex rehab manual wheelchair bases and related accessories. The second supplies an 18-month suspension of the inappropriate application of CBP payment rates – intended for DME items – to accessories/components used with CRT manual wheelchairs. A suspension of this length allows the industry time to continue working with the Centers for Medicare & Medicaid Services (CMS) to develop a permanent policy to protect these items, just as CMS did for Group 3 CRT power wheelchairs in 2017.

These protections were sorely needed, and the CRT community took that seriously. The Medicare CBP pricing being applied for critical components such as headrests, cushions, and handrims was far below sustainable. A national industry survey was conducted and revealed that 40 percent of CRT providers across the country had significantly altered their service models. This translated to reduced access to individually configured CRT manual wheelchair systems for individuals with disabilities who depend on them. It meant longer wait times, fewer options, and more frustration for providers and their customers.

Worthwhile Changes Take Time

Reaching a milestone like this in our mission to protect access to CRT is no small task, and we need to celebrate that. However, there is another foundational lesson to take from this experience. That lesson is understanding that worthwhile changes take time, unity, and persistence to achieve. It is accepting that there will be ups and downs along the way, but we must remain determined to continue the pursuit of the goal to achieve what we seek.

For three years, CRT advocates knocked on the doors of Capitol Hill time and time again to garner support for this legislation that would restore and guard access. Congress needed to be educated by their constituents about what was happening in the lives of individuals with disabilities. Our community showed up in a big way to make sure it happened. And when we did, we were heard. Providers, manufacturers, consumers, clinicians, disability groups, and industry organizations dedicated their time and resources to being on Capitol Hill for meetings with Congress. They rallied national support through grassroots e-mails, social media awareness, phone calls, published articles, and more to steadily deliver the message that change must be made.

It was this persistent and united outreach that culminated in seeing our CRT legislation included in a year-end package that was signed into law on Dec. 20, 2019. Simply put, the CRT community kept after this until the job was done. Were it not for the countless hours and unwavering effort of these advocates, people with disabilities would still be dealing with reduced access to much-needed equipment. We are grateful for the engagement that each advocate showed over the course of this process and want to send a well-deserved “thank you” for all the great work.

Thanking Our Partners

We cannot celebrate this victory without stopping to recognize our champions in Congress as well. We sincerely thank Reps. Larson and Zeldin and Senators Casey and Portman for their leadership. We're also grateful to Energy & Commerce Committee Chair Frank Pallone (D-N.J.) and Ranking Member Greg Walden (R-Ore.), Ways & Means Committee Chair Richie Neal (D-Mass.) and Ranking Member Kevin Brady (R-Texas), and Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.).

Please take a minute and send a “thank you” message to your own Members of Congress. We are encouraging people to use the links at www.protectmymobility.com to send a note of gratitude to their Members.

What Happens Next?

Now for the implementation process. CMS is developing its plans and has released its initial instructions for providers. CMS published that the wheelchair bases impacted are HCPCS codes E1161, E1235, E1236, E1237, E1238, K0005 and K0008. Additional information on accessory codes, payment rates, and claims submission instructions will be developed in the months ahead, and NCART, along with other industry stakeholders, will work with CMS on this. Those who want to receive real-time updates about this process can subscribe at www.ncart.us.

The CRT community of determined world-changers is already looking forward to building on this success. Our advocate army will be coming together on March 30 and 31 in Arlington, Va., for the 2020 Access2CRT Summit. Hosted jointly by NCART and NRRTS, this two-day event offers a wide range of CRT-focused benefits, including excellent education, advocacy, and networking opportunities. Most importantly, it allows us to meet with hundreds of Members of Congress to maintain our relationships on Capitol Hill and to ensure that CRT initiatives continue to be addressed.

We hope that your organization will be represented as we work to secure additional safeguards for the future of CRT. You can get full Summit details and sign up at www.crtsummit.com.

More change is needed, but many hands make light work and, as we’ve seen, it will be well worth the effort. Thanks to all who were engaged in 2019, and we’re looking forward to welcoming new CRT advocates as we move through 2020.

About the Author

Don Clayback is the Executive Director of the National Coalition for Assistive & Rehab Technology (NCART).

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