Dingell, Colleagues Express Concerns to CMS Regarding Complex Rehabilitation …

U.S. Representatives Debbie Dingell (D-MI-06) and Brian Fitzpatrick (R-PA-01) along with colleagues raised concerns about Medicare’s coverage and reimbursement framework for complex rehabilitation technology (CRT), including customized power wheelchair systems, in a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz. The lawmakers highlighted two specific issues: the exclusion of preventative maintenance from reimbursement and a requirement that repairs depend on a prescription dated within the prior twelve months. “Under current rules governing Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) benefit for CRT equipment, a component part must have already failed or malfunctioned before Medicare will cover any servicing of the equipment,” the lawmakers wrote. “This framework is counterproductive in two respects. First, it drives avoidable equipment failures… Second, it undermines beneficiaries’ ability to plan.”

The letter emphasized that the policies create “unnecessary and potentially harmful administrative obstacles” for beneficiaries reliant on CRT to maintain mobility and independence. The lawmakers urged CMS to modernize the framework through regulatory action, noting that “scheduled maintenance is predictable and can be arranged around a beneficiary’s care needs and daily life.” They also pointed to CMS’s “regulatory authority to modernize this framework” and called for flexibility to cover preventative maintenance on CRT systems. A copy of the letter is available here.

Key Issues in Medicare’s CRT Coverage Framework

The lawmakers’ letter outlined two primary problems with Medicare’s current policies. First, preventative maintenance for CRT equipment is excluded from reimbursement unless a component has already failed or malfunctioned. This approach, they argued, leads to “avoidable equipment failures” and makes servicing “logistically unpredictable” for beneficiaries. Second, repairs to customized power CRT equipment require a valid prescription on file dated within the prior twelve months, creating an “unnecessary and potentially harmful administrative obstacle.”

Calls for Regulatory Action and CMS Responsibility

The letter stressed CMS’s responsibility to address these gaps, noting that “tens of thousands of Medicare beneficiaries each year depend on complex rehabilitation technology to maintain their mobility and independence.” The lawmakers encouraged CMS to prioritize reforms and maintain an open discussion between offices. They emphasized that “coverage of preventative maintenance on CRT systems” would “reduce equipment failures and improve quality of life for beneficiaries.”

Context of the Letter and Next Steps

The lawmakers’ concerns focused on significant gaps in Medicare’s coverage and reimbursement framework for complex rehabilitation technology (CRT).