Support Access to Individually-Configured Wheelchairs

Complex rehab wheelchairs and essential components are used by a segment of wheelchair users with significant disabilities such as ALS, cerebral palsy, multiple sclerosis, muscular dystrophy, spinal cord injury and traumatic brain injury. For these wheelchair users, the chair is not complete, usable or even safe without the appropriate complex rehab technology components included.

Complex rehab components are not mere cup-holders or convenience items but include such items as seating and positioning systems and specialty wheelchair controls. These are medically necessary and integral to the complex rehab wheelchair being functional and useful to an individual living with a significant disability such as spinal cord injury in order to maintain their independence and participation in society. This small population depends on these individually configured products to meet their unique needs.

This specialized equipment is provided through a clinical team model and requires extensive evaluation, configuration, fitting, adjustment, or programming. These individuals have the highest level of disabilities and require individually configured complex rehab wheelchairs and critical wheelchair components to meet medical needs and maximize function and independence.

The current payment policy for complex rehab wheelchair components must be maintained and Medicare’s January 1, 2016 policy change which will apply competitive bid pricing for standard wheelchair components to complex rehab wheelchair components must be canceled based on the following:

• Reduced payment levels will seriously compromise veterans’ access to CRT wheelchair accessories that provide critical medical and functional needs such as positioning changes to provide pressure relief, postural supports to accommodate orthopedic concerns, adjustable cushions to protect against skin breakdown, and specialty drive controls for those with limited movement as well as affect the availability and development of future advanced technologies.
• Complex rehab wheelchair components need additional adjustment and fitting and rely on higher-credentialed technicians for those services.
• Medicare is inappropriately using pricing information obtained through its competitive bidding program for standard wheelchair components and applying that pricing to complex rehab wheelchair accessories that were not part of the competitive bidding program.
• This policy change is in violation of Congressional intent when it passed Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) which excluded complex rehab power wheelchairs and components from the competitive bidding program.
• The negative consequences will spread to include other people with disabilities who are covered by Medicaid and private health insurance plans since many insurance payers follow Medicare policy.

In order to avoid major access problems for people with significant disabilities who rely on specialized features and accessories, Medicare must rescind its planned January 1, 2016 payment policy change regarding critically needed components used on complex rehab wheelchairs.

Many suppliers of this equipment provide products and services for Medicare beneficiaries as well as to the Department of Veterans Affairs (VA). While the VA is often generous in providing equipment for veterans who were injured in service, the issues addressed in H.R. 3229/S. 2196 are of great importance to VetsFirst’s membership. As many of you are aware, a good portion of our members have disabilities that are not service-connected and thus, they do not get the full benefit of the VA. Therefore, we need your help to take action and support your fellow Americans with disabilities.