Advocacy & Policy
A Reward for Persistence: CRT Scores a Big Win
- By Don Clayback
- Mar 01, 2020
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 2016.
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
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.
This article originally appeared in the March 2020 issue of Mobility Management.
Don Clayback is the Executive Director of the National Coalition for Assistive & Rehab Technology (NCART).