Mobility News

Policy Update: Your Customized Wheelchair Needs Protection

And Your Wheelchair Cushion Does, Too

• By Laurie Watanabe
• Apr 08, 2020

If you use a wheelchair for a significant disability or condition, such as cerebral palsy, spinal cord injury, muscular dystrophy, ALS, or multiple sclerosis, you know that your mobility equipment is vastly different than the mass-produced, one-size-fits-most wheelchairs you see at pharmacies and airports.

But did you know that Medicare puts your wheelchair — custom fit and configured to fit you and only you — in the same insurance funding category as a standard wheelchair used by someone recovering from a broken ankle from a skiing accident?

All wheelchairs fall into Medicare’s Durable Medical Equipment (DME) benefit category, and this can endanger access to the highly specialized technology needed by people with significant disabilities.

But Isn’t the Technology Completely Different?

People with progressive or degenerative neuromuscular diseases, congenital disorders, severe injuries or trauma have very specific assistive technology needs. The industry that engineers, manufactures, builds, fits, and services those wheelchairs and components is called Complex Rehab Technology (CRT).

CRT users may be unable to independently change positions to prevent pressure injuries… what used to be called pressure ulcers or bedsores. They might need to operate their power wheelchairs by moving their heads or using their eyes rather than their hands. They might have weakness on one side that makes sitting upright very difficult. They might be losing strength as they age with their disability.

CRT isn’t just custom fit and built; it’s also much more complex to engineer, configure and service. The whole process, from determining which wheelchair and components are optimal, to fitting it precisely to the user, to building, setup and training, take a lot more time, effort and expertise than choosing an “off-the-rack” standard wheelchair.

But Medicare currently puts standard home medical equipment and specialized/customized CRT in the same category and applies or tries to apply the same insurance reimbursement policies to everything. That can make it harder for people who need CRT to get it.

As a comparison, orthotics and prosthetics — another custom-fit, custom-built type of technology — are in a separate benefit category, not part of the DME Medicare benefit.

Can Something Similar Be Done for CRT?

CRT industry, professional and consumer organizations want a separate Medicare benefit category for CRT, much as orthotics and prosthetics have. The American Association of People with Disabilities, the American Occupational Therapy Association, the Association of University Centers on Disabilities, the Brain Injury Association of America, the Christopher & Dana Reeve Foundation, the National Multiple Sclerosis Society, Paralyzed Veterans of America, and United Spinal Association are just a few that support legislative efforts to create a separate Medicare benefit category for CRT.

But I Don’t Currently Have Medicare, So This Policy Doesn’t Impact Me, Right?

Even if you don’t currently have Medicare as your insurer, Medicaid programs as well as private-pay insurance companies (think Kaiser and Blue Cross Blue Shield, for example) often base their coverage policies on Medicare’s policies. So Medicare’s policies absolutely can impact you and the technology you can access.

So What Can I Do?

CRT organizations are hoping Congress will pass a law to create a separate Medicare benefit for CRT. You can help by going to access2crt.org.

That’s where you’ll find updates and information on how you can help — such as by e-mailing your members of Congress in just a few minutes! Add your name and address to the mailing list to stay up to date.

Complex rehab technology isn’t just wheelchairs and seating. To many people and their families, CRT optimizes independence, activities, and inclusion. Keeping CRT available to those who need it is worth fighting for.