Monthly Archives: September 2016

Why CRT Needs to Be a Separate Category


When it comes to healthcare, the last thing most people think of are billing categories.  Unfortunately, something as mundane as a billing category could be the deciding factor in obtaining appropriate equipment for those who use complex rehab technology (CRT). Currently, CRT is categorized in Medicare under the heading of “durable medical equipment”, or DME. Here’s why that’s a problem:

  • This category was originally created for an elderly population.


The designation of DME was first established in the 1960s to cover the type of equipment used by people as they advance in age—such as walkers, wheelchairs and bath safety equipment. CRT users are enrolled in the Medicare program not because of their age, but because of chronic and complex disabilities. Furthermore, their equipment is far more advanced technologically than what is typically used by an elderly patient. The conditions that apply to individuals utilizing CRT every day are not the same for DME users.


  • Obtaining CRT equipment is much more involved than obtaining DME


Typically, an elderly patient receives their DME products after a trip to the doctor and a trip to the DME supplier. Someone who uses CRT, however, must have carefully documented trips to the doctor, physical therapist or occupational therapist, an assistive technology professional (ATP), and a CRT provider. Additionally, the complexity of the equipment means the user will need ongoing training, support, and maintenance.


  • Medicare has more requirements for CRT


Obtaining DME is often as simple as visiting a medical equipment supplier with a doctor’s order in hand and leaving with equipment that same day.  There are far more requirements a person must go through to obtain CRT. Complex Rehab Technology is provided through an interdisciplinary team consisting of, at a minimum, a physician, a physical therapist or occupational therapist, and credentialed personnel from an accredited Complex Rehab Technology company.  The process of assessing, measuring, ordering, building, delivering, fitting, modifying, and training often takes three months or more.


  • Congress has changed other categories before


What we’re asking for is nothing new. In the past, Congress has recognized that other special medical needs don’t fall under the DME category. Orthotics and Prosthetics is one such example. It has its own separate set of rules for standards, accreditation and billing categories. We’re asking the same thing be done for CRT users.


Help NCART convince Congress that these changes need to be made.  Make a phone call to your Congressional representatives, write letters and emails to them, or the next time your representative gives a town hall meeting in your city attend it and speak up about CRT needs. Encourage your friends and family to do the same.  Together, we can make a difference!

Celebrate National Rehab Week by Advocating for Those Who Use Complex Rehab Technology


The week of September 18-24 marks National Rehab Week, and NCART urges you to celebrate it by bringing attention to those who use Complex Rehab Technology. With your help, we can make sure that Washington hears the voices of those who most need this lifesaving equipment. Here are just a few ways you can do that:

Bring Attention to It at the Grassroots Level

Changes in our political landscape start at home. Those who are federal and state legislators now often start off as members of the city council or board of supervisors. Contact the mayor or board secretary and ask to be added to the next meeting’s agenda. Speak about the issues facing those who use CRT, and what problems the disabled community is facing on a locally. Don’t get discouraged if nothing happens right away. Often, you need to speak up regularly at local meetings before you start seeing change. Use the Tools for Telling the CRT Story on our website as a start.

Make Sure Your State Legislators Are Aware of the Issues

The next step is to contact your legislators at the state level. Many times, state-level coverage and funding dictate the availability of CRT products and supporting services. We’ve included links to the Medicaid policy in each state here. If you need help understanding what the issues are in your individual state, you can visit the Kaiser Family Foundation or contact NCART directly.

State legislators are usually more attentive than those at the federal level. Because they remain in the state where they are elected, they are more connected with their electoral base. Often, they will base their vote off of how many constituents they hear from on a given issue. Even if only one person speaks up to them, it will be enough to sway their vote!

Write to Your Federal Legislator

Just like with state legislators, a legislator at the federal level will sometimes vote according to what he or she hears from their constituents. Often, an overwhelming amount of letters on a given issue will be their deciding factor. The key is to keep letting our voices be heard! Like at the grassroots level, we need to be patient and continue to speak up until change happens.

At NCART, we are dedicated to helping those who use CRT have their voices heard and ensuring that they have access to the equipment they need. Join us this September 18-24 in celebrating National Rehab Week by kicking off grassroots, state and national efforts to make sure the CRT story is heard!

Problems with Cost Plus Payment in CRT

United States Coins.

United States Coins.

Complex Rehab Technology (CRT) products are specialized and customized to fit each individual’s needs. These products are provided to individuals with significant disabilities in order to address their medical and functional needs.

When determining the cost of CRT products, the cost of the product, cost of the service, delivery and support system must be recognized. The cost of the product itself is only about half of the actual cost of providing the equipment. CRT studies have found that for every dollar of funding, product cost is approximately 49 cents and service cost is approximately 46 cents. To make sure that people with disabilities are able to access the CRT equipment they need, a funding system must incorporate the total costs of providing the product and the supporting services. Because of these operational and financial challenges, there are only a limited number of companies that will supply CRT and that number is decreasing.

Problems with Cost Plus Payment Methodology

  1. Unless the Cost Plus methodology incorporates all costs of products and services with an appropriate multiplier, it does not provide appropriate payment rates.
  2. A Cost Plus system is time consuming for the payer. Since CRT orders are so complex, there may be 20 to 30 invoice line items to review on each claim. This creates additional administrative burdens.
  3. A Cost Plus system penalizes CRT suppliers and rewards companies that don’t. Because dedicated suppliers buy more products, they will typically have a lower product cost compared to the company that buys fewer products. The result of this is a supplier getting paid less than a company that has made a smaller investment.
  4. A Cost Plus system reduces the supplier’s desire to negotiate better acquisition costs.

Alternative Payment Methodologies  

  1. Use published Medicare Fee Schedule to ensure that the most current fee schedules are in place.
  2. Use Manufacturer’s Suggested Retail Pricing (MSRP) to decrease the likelihood that a supplier will provide a low quality product.
  3. Use a combination of Medicare Fee Schedule and MSRP. Use the Medicare Fee Schedule for coded items and MSRP for non-coded items.

There are a number of problems with applying the Cost Plus payment methodology to CRT. The National Coalition for Assistive and Rehab Technology (NCART) works hard to make sure that individuals with disabilities have access to CRT products and services. Contact us to find out how you can help!

Wheelchair Accessories Legislation Gains Support

August 31, 2016

Wheelchair Accessories Legislation Gains Support

CRT Stakeholders and Friends,

Yesterday Representative Lee Zeldin (R-NY), the House sponsor of our complex wheelchair accessories bill H.R.3229, held a press conference at The Children’s Center at United Cerebral Palsy (UCP) of Long Island, a school for students with developmental disabilities. The purpose of the press conference was to call for Congress to pass H.R.3229 this year, legislation that he labeled as a “must pass” bill to protect access for people with disabilities.

Other CRT stakeholders in attendance also spoke in support. These included Stephen Friedman, President and CEO of UCP of Long Island; Rolf Walter, a 50 year client of UCP who uses a CRT power wheelchair; and Linda Bollinger-Lunger, a physical therapist with Long Island Select Healthcare who has been delivery CRT seating and mobility for 17 years. All three did a very good job in emphasizing the critical need to protect access to CRT and for Congress to pass this bill.

The press conference was well attended and Representative Zeldin was joined by local elected officials, staff of UCP of Long Island, residents from UCP of Long Island’s 31 homes, advocates for individuals with disabilities, and members of the community. You can view the 20 minute press conference here and the related press release can be found here.

In addition to the press conference, national consumer, patient, and clinician organizations have once again communicated in writing to Congress urging passage of H.R.3229/S.2196.

The Consortium for Citizens with Disabilities (CCD) sent a supporting letter signed by 26 national organizations to Congress on August 18th. The ITEM Coalition followed up with a similar letter signed by 37 national organizations on August 25th. Those letters can be found and downloaded here.

We sincerely thank Representative Zeldin and the members of the CCD and the ITEM Coalition for their continued leadership and support.

These positive developments come at an excellent time and let Congress know this legislation must be passed this year. The documents and information can be shared as part of your follow up with the offices of your Representative and Senators. We need all 3 of your Members signed on as co-sponsors to build on this momentum!

Congress will be back in session starting next Tuesday for most of September and next week is the ideal time for follow up. Use the resources at to see if your Members have signed on and to make additional outreach as needed.



Donald E. Clayback
Executive Director | NCART
Office 716-839-9728 | Cell 716-913-4754 |