Summary:
Senators Marsha Blackburn and Tammy Duckworth introduced a bipartisan bill, the Choices for Increased Mobility Act, to improve access to advanced wheelchairs for Medicare beneficiaries by reducing upfront costs.
Key Takeaways:
- The bill allows Medicare beneficiaries to upgrade to lighter, advanced-material wheelchairs without paying the entire cost upfront.
- New billing codes would distinguish between standard and upgraded wheelchairs, allowing Medicare to cover a portion while beneficiaries pay only for specialized materials.
- This legislation aims to improve mobility, reduce physical strain, and enhance quality of life for individuals reliant on these wheelchairs.
U.S. Senators Marsha Blackburn (R-Tenn) and Tammy Duckworth (D-Ill.) introduced the Choices for Increased Mobility Act to increase access to wheelchairs made with advanced materials by allowing Medicare beneficiaries to upgrade to lighter, more functional wheelchairs without bearing the entire upfront cost. These manual wheelchairs help prevent shoulder injuries, enhance maneuverability, and reduce overall pain and fatigue for users.
Further Reading: The Key to Complex Rehab Coverage for Power Bases and Seats
“Too many Americans with disabilities face unnecessary barriers to obtaining the best mobility equipment to meet their needs,” said Senator Blackburn. “By making it easier for Medicare beneficiaries to upgrade to wheelchairs made with advanced, lighter materials like carbon fiber and titanium, this bipartisan bill would help improve the quality of life for countless individuals. I’m pleased to work with Senator Duckworth to reduce financial burdens on those who rely on these essential devices and ensure that more people have access to the mobility solutions they deserve.”
“For too long, Medicare recipients have struggled to access lighter, more functional wheelchairs that would help them get around more easily while putting significantly less strain on their bodies,” said Senator Duckworth. “Our bipartisan legislation would help ensure Medicare recipients are better able to access the wheelchairs they need to live healthier, more independent lives—with minimal cost to the federal government. It’s a win-win.”
Background: Challenges for CRT Providers
Complex Rehab Technology (CRT) is a specialized subset of the Durable Medical Equipment benefit, which includes highly configurable manual and power wheelchairs, adaptive seating, and positioning systems. Among these, manual wheelchairs constructed from advanced materials like carbon fiber and titanium are significantly stronger and lighter than standard aluminum wheelchairs.
When the Medicare billing code for ultra-lightweight manual wheelchairs was established in 1993, materials like titanium and carbon fiber were not considered, as they were not yet in use for wheelchairs. As a result, CRT providers have struggled to supply wheelchairs with these advanced materials at the fee schedule amounts set by Medicare.
Historically, Medicare allowed beneficiaries who met medical necessity requirements to upgrade their equipment by paying the difference between standard and upgraded materials. However, a policy change in 2016 removed this option, requiring beneficiaries to prepay the entire cost of the wheelchair out-of-pocket and await reimbursement for the standard portion, significantly limiting access to these advanced wheelchairs.
Choices for Increased Mobility Act
The Choices for Increased Mobility Act would create two new billing codes for ultra-lightweight manual wheelchairs: one for base models and another for those constructed with titanium or carbon fiber. This change would allow Medicare beneficiaries to upgrade to lighter, more functional wheelchairs without bearing the entire upfront cost. Instead, beneficiaries would only pay for the cost of the specialized materials, significantly reducing their financial burden.
This bill aims to restore the option for beneficiaries to choose and pay for advanced materials for their wheelchairs without removing medical necessity requirements. It would ensure that Medicare covers the standard portion of the wheelchair cost, with beneficiaries responsible only for the upgraded materials.
Featured image: Capitol Hill in Washington DC. Photo: Dreamstime