Does Advocacy Really Make a Difference?
By Mickae Lee, National Coalition for Assistive and Rehab Technology (NCART)
All advocacy action begins not just with acknowledging that change is needed, but also believing that change is possible. In the world of Complex Rehab Technology (CRT) we know without a doubt that access to innovative technology for individuals with disabilities is an ever-growing necessity. That is why this community has been and always will be passionate advocates for making that access a reality.
Working together, this community has reached new heights and from here we can see all kinds of possibilities on the horizon. The path toward establishing Medicare coverage for power seat elevation and power standing systems used with complex power wheelchairs is a prime example.
Battle for Medicare Coverage Hinged on Advocacy
It all began with personal experiences backed by clinical evidence demonstrating how power seat elevation and power standing systems provide significant medical benefits to people with disabilities and enable them to be much more independent in their homes and communities. However, not everyone had access through their insurance plans—Medicare enrollees in particular. Change was needed and we believed it was possible. That was the beginning of this particular advocacy journey.
In September 2020, the ITEM Coalition (a coalition of patients, providers, researchers and other subject matter experts) submitted a formal "Request for Reconsideration of the existing National Coverage Determination (NCD) for Mobility Assistive Equipment" to advance a coverage policy for these systems under the Medicare Durable Medical Equipment (DME) benefit. We needed the Centers for Medicare and Medicaid Services (CMS) to agree that these systems were medical in nature and as such, should be a covered benefit in the Medicare program.
After the formal request was submitted, thousands of advocates took further action by contacting their Members of Congress and asking for support in our efforts to secure coverage. Congress heard us and responded to that outcry by communicating with the Department of Health and Human Services (HHS) and CMS to urge forward movement in the process of establishing coverage.
In August 2022, nearly two years after the initial request was submitted, CMS took action and opened the public comment period for power seat elevation systems. (They did not open the related review of power standing systems at the same time, but we will continue to pursue that coverage in the future.) Over 3,500 comments were submitted by clinicians, individuals with disabilities, providers, manufacturers, advocacy organizations and others. This outpouring of unified support sent an incredibly strong message to CMS regarding the need to establish coverage for this important technology.
In February 2023, after taking time to read through all of the comments that had been submitted, asking for additional information and speaking with CRT advocates, CMS shared draft Medicare coverage criteria for power seat elevation systems. Once again, our community had an opportunity to provide feedback on what Medicare would ultimately decide and once again, advocates met the challenge prepared and with determination as another 2,100 comments were submitted in response.
CRT Win! Medicare Now Covers Seat Elevation on Power Wheelchairs
In May 2023, after yet another round of reviewing comments, CMS officially posted its final Benefit Category Determination (BCD) and National Coverage Determination (NCD) for power seat elevation systems used with Group 2, 3 and 5 power wheelchairs. The coverage was in line with what advocates had pushed for and applied to both traditional Medicare and Medicare Advantage plans. To sum it up, it was a huge win.
Now, both CMS and CRT advocates are working together to determine the specifics of coding and reimbursement for these systems. This is another incredibly important part of the process where advocacy action is being taken because it directly impacts whether or not providers will truly be able to supply these systems to Medicare enrollees and others whose insurance plans follow Medicare's lead. NCART and others are currently providing additional data to CMS and there will be another public meeting this fall. Final implementation of coverage is anticipated in 2024. In the meantime, these systems are a covered benefit and the local Medicare contractors (DME MACs) have the authority to determine coverage for seat elevation systems in their own regions. Local CRT providers can offer more information to individuals who qualify for them.
This advocacy victory required years of consistent and collaborative efforts from the entire CRT community, and we are thankful to each and every advocate who took action along the way. Margaret Mead once said, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."
Advocates for Complex Rehab Technology are superheroes in our eyes, and they look just like you. They are individuals with or without disabilities; clinicians, students, family members, spouses, employees, caregivers, engineers, teachers, suppliers, manufacturers or any other person with a passion for protecting access to CRT and a belief that their voice matters—and it absolutely does.
To learn more about the advocacy work that is being done to enhance and protect access to CRT and how you can get involved, visit www.ncart.us.
About the National Coalition for Assistive and Rehab Technology (NCART)
The National Coalition for Assistive and Rehab Technology (NCART) is the only national non-profit organization of suppliers and manufacturers of Complex Rehab Technology (CRT) products and services used by individuals with disabilities. NCART seeks to ensure these individuals have adequate access to CRT products and supporting services. In pursuit of that goal, NCART works with consumers, and clinicians, along with federal, state and private policymakers to establish and protect appropriate coverage, coding, funding and supplier standards policies.
About the Author:
Mickae has over 15 years of experience in the CRT industry. Prior to her work with NCART, she worked for a CRT provider as a customer service representative, Medicare and Medicaid biller, and CRT document review specialist.
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