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 www.access2crt.org 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
dclayback@ncart.us |www.ncart.us

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 http://bit.ly/2asMKDa.

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
dclayback@ncart.us | www.ncart.us

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
dclayback@ncart.us | www.ncart.us

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 www.ncart.us 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.

CRT Education and Advocacy in Washington, DC July 12-14

CRT Education and Advocacy in Washington, DC July 12-14

CRT Stakeholders,

This is a critical year for taking the CRT message to Congress.

We need to build on the significant progress we have made and push for passage of legislation to prevent significant payment cuts to CRT wheelchair accessories on December 31 (H.R. 3229 and S. 2196) and to create a separate CRT benefit category (H.R. 1516 and S. 1013).

With that in mind, CRT stakeholders are encouraged to sign up for the “new and combined” 2016 Assistive Technology Conference being held July 12 to July 14 at the Hyatt Regency Crystal City in Arlington, Virginia being presented by RESNA, NCART, and NRRTS.

Attendees will benefit from a continuation of sessions covering business topics for the management teams of CRT providers and manufacturers plus funding and advocacy topics for all CRT stakeholders regarding the latest CRT Medicare and Medicaid trends, issues, and advocacy strategies.

In addition, the CRT “business” sessions are now supplemented by great CEU-earning seating and mobility workshops designed for the practicing Rehab Technology Professional.

Most importantly, July 14 will be Capitol Hill Day enabling everyone to take the CRT message directly to Congress. Providers, manufacturers, consumers, clinicians, and other advocates will spend the day making in-person visits to Members’ offices. Once you sign up, we’ll make the appointments for you.

So come join other CRT stakeholders for unparalleled continuing education, networking, and advocacy!

You can get more details and register online at http://www.ncart.us/crtconference.

Get Excited! It’s almost time! Preview of the 2016 RESNA/NCART Conference, Part 2


In our previous blog, we highlighted some of the things we’re looking forward to during the 2016 RESNA/NCART conference. We would like to continue that preview for today’s blog:

CRT Legislative and Regulatory Update

The policy landscape for CRT is ever-changing, and this session’s aim is to keep attendees abreast of those changes. Industry experts will provide a comprehensive look at what’s going on at both the federal and state levels. Some of the things covered will include: Medicare Separate Benefit Category legislation, Medicare’s application of Competitive Bid pricing to CRT wheelchair accessories, other Medicare issues and state CRT legislation.

Seating, Mobility, and CRT Show and Tell

Just as the regulations surrounding CRT are constantly changing, so are the technologies going into them. This session will allow attendees to have a hands-on demonstration of recent emerging and innovative technologies for Complex Rehab Technology.

Capitol Hill Visits

If you have a stake at all in the world of Complex Rehab Technology, we would encourage you to attend this event! During this visit, you will have direct access to the policy makers who impact the legislation around CRT. Participants will be able to meet with both their senators and representatives in Congress. Those who do sign up for the Capitol Hill Visit will be required to attend the session titled “Congressional Prep for Capitol Hill Visits” The session will equip you with talking points about specific target issues, as well as familiarize you with the logistics of the visit.

The actual time that you visit with congressional members will vary. Since you will meet with the representatives from your area, everyone will meet with different legislators, and not all of them are on the same schedule. Remember, if you attend this session, you will need to dress appropriately! Dark suits for men, and pants or skirt suits for women.


We’re looking forward to seeing all of our supporters at this year’s conference! You can find full conference information here.

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