April 30, 2019
Rep. Sensenbrenner: “Individuals with significant medical conditions like cerebral palsy, muscular dystrophy, multiple sclerosis, and spinal cord injuries face unique physical and functional challenges. Many of these individuals rely on complex rehabilitation technology products to meet their medical needs and function on a daily basis. I’m proud to reintroduce this bipartisan legislation that would allow for targeted coverage and payment policies that address the unique situations of people with severe medical needs.”
Rep. Higgins: “The reimbursement criteria for many of the devices used today was developed a generation ago, before some of this technology was available. This bipartisan legislation is an effort to remove bureaucratic barriers that create unnecessary challenges for families and provide easier access to services and complex medically necessary equipment for those with severe disabilities.”
Currently, Medicare includes complex rehabilitation equipment in the same category as standard durable medical equipment – i.e., traditional manual wheelchairs. However, individuals who use complex rehabilitation technology products tend to differ from the traditional Medicare population and have vastly different needs. Furthermore, these complex and often customizable products require a broader range of services and specialized personnel, as well as much more training and education for suppliers to ensure appropriate use.
Under H.R. 2408, Medicare would cover complex rehabilitation technology under a separate benefit category. This separate category would allow for targeted coverage and payment policies that address the unique situations of this specialized subset of durable medical equipment and the people with disabilities it serves.
Additionally, to help prevent fraud and abuse, the legislation would establish clinical conditions for coverage that ensure these items are prescribed appropriately. Whenever prescribed, a licensed physical or occupational therapist with no financial relationship to the supplier would have to conduct an evaluation. This will ensure program safeguards by increasing quality standards for suppliers of these items.
H.R. 2408 is supported by the American Association for Homecare, American Physical Therapy Association, Brain Injury Association of America, Christopher and Dana Reeve Foundation, Easter Seals, National Association for Home Care & Hospice, National Coalition for Assistive and Rehab Technology, National Council on Independent Living, National Multiple Sclerosis Society, National Registry of Rehabilitation Technology Suppliers, Paralyzed Veterans of America, United Spinal Association.