Persistence and passion: CRT accessories win culminates multi-year effort

CMS’ decision to exempt manual CRT accessories from bidding-derived pricing culminates long-term, multi-stakeholder effort to protect CRT benefit.

In late 2014, CMS announced plans to begin using results from the competitive bidding program for standard power and manual wheelchair accessories to determine pricing for accessories CRT wheelchairs. HME leaders and patient groups pushed back against the proposal, citing clear Congressional intent to exempt CRT products from the bidding program as part of 2008 MIPPA legislation that paver the way for the competitive bidding program.

CMS remained undeterred and planned to move forward with the proposal, which would have resulted in substantial cuts for CRT accessories, effective January 2016.

HME mobility advocates worked with a broad range of patient advocates and CRT champions on Capitol Hill to generate support for protecting CRT accessories. These efforts led to bipartisan legislation to delay implementing CMS’ planned cuts for a year was approved by the House and then was passed through the Senate via the rarely utilized “hotline” process.

After Congress granted another six-month reprieve as part of comprehensive CURES legislation in late 2016, AAHomecare and other mobility stakeholders kept the pressure on for a longer-term solution. The House and Senate again introduced legislation in March 2017, this time seeking to permanently protect CRT accessories.

Eight days before the Congressionally mandated exemption was set to expire, CMS finally issued a policy statement granting permanent relief for CRT accessories. But the measure didn’t protect the full scope of these accessories; instead, only items used with power CRT wheelchairs were exempted.

The mobility community and our long-time supporters in the House and Senate remained undeterred in their efforts to fully and completely resolve the issue, introducing additional legislative packages over the next two-plus years to protect manual accessories and leading to an 18-month exemption for manual CRT as part of December 2019 Appropriations bill. Congressional sign-on letters in September 2020 and again in June 2021 helped keep the pressure on CMS to fully protect CRT accessories.

Just days after the 2021 letter, CMS announced an additional 90-day extension to keep manual CRT exempt, followed by last Friday’s Final Rule announcement that finally brings a six-and-a-half year campaign to protect the full scope of manual CRT accessories.

“Persistence and passion; that’s what it takes to succeed on Capitol Hill,” said Tom Ryan, AAHomecare president & CEO. “The commitment of mobility advocates and our patient group allies to keep the pressure on legislators over several years is inspiring and amazing.”

“Our partners at NCART and patient groups such as the ITEM Coalition, United Spinal Association, Paralyzed Veterans of America, and the ALS Association were instrumental in raising the visibility of this issue with policy makers and deserve special recognition for their long-term advocacy on CRT issues,” Ryan added.

AAHomecare would also like to put a spotlight on the most steadfast CRT champions on Capitol Hill, who sponsored and build support for multiple bills and sign-on letters through three Congressional sessions: Rep. John Larson (D-Conn.), Rep. Lee Zeldin (R-N.Y.), Sen. Bob Casey (D-Pa.) and Sen. Rob Portman (R-Ohio).

CMS estimates that exempting manual CRT accessories from bidding-derived pricing will result in $40 million in increased payments for suppliers from FY 2022 to FY 2026. For power CRT accessories, the impact is $130 million more to suppliers over the same period. The total positive impact for CRT providers over the next five years: $170 million. These figures don’t account for the hundreds of millions in cuts that have already been prevented though various delays in applying bidding-derived pricing since 2016 and the permanent exemption for power CRT accessories gained in 2017.

Six-plus years of sustained effort results in millions of dollars towards CRT providers’ bottom lines – and more importantly, it helps these providers continue to support patients and caregivers who depend on CRT to protect their well-being and chance their quality of life. That’s a return on investment the HME community can be proud of.