CRT Wheelchair Accessories Legislation Update

October 6, 2016

CRT Wheelchair Accessories Legislation Update

Can December 31 major Medicare payment cuts to Complex Rehab wheelchair accessories be stopped?  The solution rests in getting Congress to pass needed legislation before year-end.

While Congress is currently in recess for the elections, they return on November 14 for the “lame duck” session.  This year-end session will be a hectic time, but it’s the opportunity for passage of House bill H.R. 3229 and companion Senate bill S. 2196 to stop these cuts.

To help publicize the issue and get more folks to reach out to Congress an ad was placed in an Assistive Technology Insert published last Friday in USA Today in the cities of Chicago, Dallas, Los Angeles, and New York City.  Share the ad with others in your circle of friends, associates, and organizations to get them to let Congress know this legislation MUST get passed this year.

The legislation also received a boost from a September 28 letter to Congress from the National Disability Leadership Alliance. Sincere thanks goes to them for their support.

As we look toward year-end we have a solid base of support from 145 Representatives on H. R. 3229 and 25 Senators on S. 2196.  The co-sponsor list can be found here.  But getting significant support is not the same as getting a bill passed.  We need to leverage our progress and get Congress to pass the legislation before they adjourn in December.

To make that happen Members of Congress must continue to hear from their constituents over the next several weeks as they discuss priorities and plans for the lame duck session.  The message to them is the Complex Rehab wheelchair accessories bill is “must pass” legislation.

With that in mind, please reconnect with your Members using the email here or by calling them through the Congressional switchboard at 202-224-3121.  If they are already a co-sponsor, thank them and emphasize the need to pass this legislation when they come back after elections.  If they are not signed on yet, make that request and stress the need for passage.

There’s a great deal at stake.  People with disabilities continued access to needed Complex Rehab wheelchairs and accessories depends on Congress passing H.R. 3229 and S. 2196 this year.  It’s up to us to help Congress do the right thing.

Thanks for taking the time to reconnect with your Members and being part of the year-end push.  Let us know if we can be of assistance and we’ll keep you posted as we move ahead.


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

P.S. If you know of other CRT stakeholders who would like to receive these types of updates please have them sign up at the NCART website.

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 |

Remembering Simon Margolis

July 26, 2016

CRT Stakeholders and Friends,

It is with deep sadness we share the news that longtime leader and friend Simon Margolis passed away yesterday.

For those who didn’t know Simon, he spent his career as an Assistive Technology (AT) and Complex Rehab Technology (CRT) practitioner, industry leader, and advocate.

And even more important than that, he was a good man.

I knew and worked with Simon very closely in different capacities for over 30 years. And many others in the AT and CRT arena had that same honor. He was a great guy to have leading an initiative or as a member of your team.

When it came to CRT, Simon was all in. His many contributions to promoting access to the technology and services that improve the lives of people with disabilities are far too numerous to list.

As Gary Gilberti, past NCART President, said “As a clinician, provider, manufacturer, inventor, accreditation surveyor, or organizational leader Simon wore many hats and brought diverse perspectives to all his conversations”.

It is amazing when you look at the various roles and organizations Simon had a significant and positive influence on. During his career he was part of the leadership of all three major AT/CRT organizations. And he was part of the actual creation of two of them.

At RESNA, he served on the Board of Directors and as President. At NCART, he was one of our founders and served on our Board of Directors. And most importantly, at NRRTS he was one of the founders where he served on their Board, served as President, and then led NRRTS for seven years as Executive Director until his premature retirement in August 2013 due to health issues.

In all these positions, Simon’s passion and dedication had a common goal: protecting and improving access to high quality individually configured equipment that people with disabilities rely on and ensuring it was provided by qualified professionals and organizations.

Our heartfelt condolences go out to his wife Marcia, his daughter Erica Negrini and son-in-law Tyler. Marcia and Erica were the real stars in his life and his love for them was evident in his personal conversations.
You can convey your thoughts to the family at

Some people say when they die, they’d like their legacy to be that “I left the world a little better than it was when I came into it”. Simon can rest in peace knowing his dedicated contributions left the world much better for people with disabilities and for those of us who knew and worked with him.

Thank you Simon for the example you left us to follow. We will continue to advocate (fight) for access to CRT in your memory.



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

DME Rural Relief Legislation Did Not Pass

July 18, 2016

NCART Board and Supporters,

Unfortunately the Congressional legislation to impose a 3 month delay to the implementation of the July 1 DME cuts failed to pass the Senate on Friday.

Accordingly, the July 1 cuts will remain in effect unless Congress takes action when they return in September after their summer recess.

The 3 month delay legislation had passed in the House. But it failed to pass in the Senate on Friday due to a “hold” placed by an unidentified Senator as part of the Senate’s “hot line” process.

This further emphasizes the need to secure passage of H.R. 3229 and S. 2196 to stop the application of competitive bid rates to CRT power and manual wheelchair accessories.

We had a very good showing and discussions in Congress last week to secure passage of the CRT accessories legislation.

We will be sharing more details on that and on needed next steps shortly.


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

What do we mean by accessories?


The fight to protect access to CRT accessories has been at the forefront of our legislative discussion. From delaying the application of competitive bid rates to the CMS’ ruling on billing instructions that directly violates S-2425, it’s the issue that has garnered the most attention. But what exactly are we talking about when we refer to CRT accessories?

We’re not talking about frills. The term “accessory” can be deceptive, as it brings to mind items that are nice but not necessarily needed. When we’re talking CRT, accessories include items that are vital to the user’s life and health.

Cushions are not a luxury. In many cases, accessories include things such as seating and positioning cushions. Just like the word “accessory,” this can also bring to mind something that’s a luxury and not a necessity. For CRT users, however, it’s the exact opposite. These cushions and seating positions keep them from developing sores and placing stress on the wrong muscles. It keeps them healthy while using their wheelchair for everyday life.

They include things that are essential to operating the wheelchair. It would be impossible to operate a wheelchair without the wheels or joystick. Yet, all these things are included in the accessory category. They also include miscellaneous parts that keep the chair going. If one of those parts goes out, it can be impossible for CRT users to get it replaced due to the red-tape and lack of funding.

Getting the right accessories is more difficult than it seems. Because of how the system is currently set up, CRT users often end up having to search for a CRT provider who will still supply the equipment.  Or even worse, they’re being provided less-than-ideal equipment, which leaves them unable to lead independent lives.

NCART and other CRT stakeholders continue to fight to protect accessories used with Complex Rehab Technology by promoting our federal legislation related to the issue.  H.R. 3229 and S. 2196 would permanently prevent CMS from applying Competitive Bid pricing to these specialized accessories. Visit to learn more about how you can help join the fight!


How to tell your CRT story to your legislator


If you’re lucky enough to attend the 2016 RESNA/NCART Conference, then you might be looking at the possibility of meeting with your legislator. While this may seem intimidating, it can actually be an excellent chance to tell your CRT story. Here are a few tips on how to make it successful:

  • Start with an introduction—who you are, where you live, what your connection is with the CRT world. If you use CRT, tell them for how long, even if it’s been your whole life.
  • Think of a specific personal incident that highlights why CRT is so important to you (if you use it) or to the people with whom you work. It doesn’t have to be dramatic or extreme to be impactful—just honest.
  • Talk about how current legislation impacts your or your clients’ access to CRT, and what changes need to be made.
  • Ask for a commitment to support legislation that will make access to CRT easier.
  • At the end of the meeting, remember to thank them for their time.

You can use these bullet points as a template to frame your story before you meet with legislators. The last thing you want is to walk out of the meeting thinking, “Oh, I should have said THIS!” Practice it several times beforehand. Legislators are pressed for time, so you don’t want to stumble as you try to find the word to convey what you want to say.

Remember to be real! This is your story, and you are the expert on this issue. It’s impossible for legislators to know everything about the topics they vote on, and they often rely on stories and input from their constituents before deciding how to vote. Your one visit can make all the difference.

If you find yourself stuck as you try to frame your story, our website has examples of other people telling their CRT story. Check out our video library for some inspiration.


CMS Releases July 1 Medicare DME Fee Schedules with Major Cut

June 24, 2016

CRT Stakeholders and Friends,

Late yesterday afternoon CMS finally released the July 1 Medicare DME Fee Schedules. A mere 5 business days before the reduced payment amounts go into effect!

As feared, the payment reductions due to the full application of Competitive Bid Program information, including new data from the recent Round 2 Recompete, are major.

Unfortunately HME legislation to delay these cuts was passed in the Senate on Tuesday, but a similar bill in the House that was scheduled for a vote Wednesday was never acted on due to the Congressional “sit-in” and the subsequent adjournment of the House until July 5.

The related CMS Fact Sheet can be found here. Based on that document, the July 1 payment amount cuts (from 2015 payment amounts) for DME items include: Oxygen Concentrator 56% cut; Nebulizer 68% cut; Hospital Bed 55% cut; Walker 58% cut; Commode 56% cut; Standard Manual Wheelchair 60% cut; and Standard Power Wheelchair 53% cut.

The detailed July 1 Fee Schedules can be found here.

We are in the process of analyzing the July 1 payment cuts that apply to wheelchair accessories and will report that information as soon as our analysis is complete.

These major reductions further underscore the need for us to push for passage of H.R. 3229 and S. 2196 this year to protect accessories used on complex rehab power and manual wheelchairs!

More also to follow on that.

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