NCD Letter to CMS regarding complex rehabilitation technology

Wednesday, August 4, 2021

Ms. Chiquita Brooks-LaSure
Administrator, Centers for Medicare & Medicaid Services
U.S. Department of Health & Human Services
200 Independence Ave., S.W., Mail Stop 314G
Washington, DC 20201

Dear Administrator Brooks-LaSure:

I write on behalf of the National Council on Disability (NCD) - an independent federal agency that advises the President, his Administration, Congress, and federal agencies on disability policy - to respectfully request a meeting with you and your staff to discuss effective policies that will address barriers currently experienced by as 11 million people in our country and territories, including an estimated 85,000 veterans with mobility disabilities who rely upon the use of mobility devices in their daily lives. The purpose of the meeting is to discuss Medicare’s coverage determination for power wheelchairs with features such as power seat elevation, power standing, balancing and other features permitting wheelchairs to drive up and down steep inclines and over a wide variety of terrain, and climb up and down stairs, all of which is referred to as complex rehab technology (CRT).1

We just celebrated the 31st anniversary of the Americans with Disabilities Act, landmark comprehensive civil rights legislation for people with disabilities containing an overarching federal promise to remove barriers to provide all persons with disabilities in the United States and in our territories an equal opportunity to integrate and participate fully in all aspects of our society. The Center for Medicare and Medicaid Services’ (CMS) existing policy and approach to approving CRT hinders fulfillment of that federal promise and significantly stifles millions of people with mobility disabilities who rely upon the use of mobility devices and who desire or require CRT to live full independent and self-directed lives.

Over the years, NCD has heard from persons with mobility disabilities throughout the country and in our territories, their loved ones, their caregivers, as well as from rehabilitation technology professionals, CRT suppliers, and physicians for persons with mobility disabilities desiring or requiring CRT, all conveying the need for Medicare coverage of CRT. Coverage of CRT with such features as outlined above permits persons with mobility disabilities to equally maneuver within their homes and within the communities where they live. Such features offer significant medical benefits including prevention of skin breakdowns and muscle fractures by increasing mobility and muscle tone, increasing strength and bone density and overall cardiorespiratory health. Coverage of CRT with such enhanced features can, in turn, enhance the psyche and mental health and well-being of its users by increasing social engagement inside and outside the home, reducing social isolation, resulting in increased inclusion and a greater sense of independence. For those not spending 16 – 19+ hours a day, seven days a week, in power wheelchairs, these features can mistakenly be characterized as a luxury; they are not. For the reasons stated above, those features are a necessity to its users.

Without Medicare coverage of CRT, the millions of people with mobility disabilities who desire or require those features described herein are left with very few options by which to acquire a power wheelchair with such technology. As goes Medicare in its coverage determinations with respect to CRT so goes private insurance payers who largely mimic Medicare in establishing their own coverage determinations. Coverage of CRT will also send a signal to manufacturers of such power wheelchairs and incentivize them to invest in research and development to enhance the technology in existing wheelchairs which, heretofore, has changed very little over the past four decades. Manufacturers will invest in technology enhancements to improve mobility, safety, comfort and accessibility.

Advancing broader coverage of mobility technology is not a novel matter for the National Council on Disability. NCD has released multiple reports regarding the struggles people with disabilities have incurred in their attempt to access durable medical equipment appropriate to suit their needs. In 2009, NCD authored a report titled, The Current State of Health Care for People with Disabilities, wherein NCD recommended:

The Centers for Medicare & Medicaid Services (CMS) should update their current definitions of durable medical equipment and medical necessity, which are outdated and give little consideration to increasing an individual’s functional status. The current patchwork of both Federal and state health care and private insurance coverage contains barriers and gaps that leave many people with disabilities unable to obtain needed assistive technology.2

In 2016, NCD renewed these concerns and recommendations:

A person with a severe disability may need wheelchair accessories such as standup features, the Centers for Medicare and Medicaid Services (CMS) does not provide clear definitions to distinguish complex rehabilitation technology (CRT) from durable medical equipment (DME). Action is needed to enable all people with disabilities to have access to the necessary technology that will give them the ability to achieve equal access to opportunity, inclusion, and self-determination.3

We look forward to meeting with you and your staff to discuss how Medicare coverage for CRT will remove barriers for people with mobility disabilities. As a matter of courtesy, Amy Nicholas, NCD Senior Staff Attorney will reach out to your office on August 16, 2021 to coordinate a date and time for our meeting. In the event you or your staff would like to communicate with us before then, Ms. Nicholas can be reached at anicholas@ncd.gov and you may reach me at agallegos@ncd.gov.

Respectfully submitted,

Andrés J. Gallegos
Chairman

1 CRT is the category of durable medical equipment for people with complex, typically permanent disabilities who are unable to use standard durable medical equipment (see https://www.ncart.us/uploads/userfiles/files/CRT%20Definition%206-1-14.pdf) (Accessed April 27, 2021)

2 National Council on Disability, The Current State of Health Care for People with Disabilities, NCD.gov, *[The Current State of Health Care for People with Disabilities

NCD.gov](https://ncd.gov/publications/2009/Sept302009)*

3 National Council on Disability, National Disability Policy: A Progress Report-October 2016, NCD.gov, [National Disability Policy: A Progress Report - October 2016

NCD.gov](https://ncd.gov/progressreport/2016/progress-report-october-2016)