Bill seeks to eliminate prior authorization for wheelchair repairs

WASHINGTON – Rep. Ayanna Pressley, D-Mass., has introduced legislation that would remove prior authorization requirements from Medicare Advantage plans for maintenance and repairs to wheelchairs and other complex rehab technology (CRT).

“When a wheelchair breaks down, daily life is disrupted,” said Pressley. “I’m grateful to my constituents and our disability justice advocates for informing this vital legislation.”

Pressley announced the “Facilitating Access to Service and Timely Repairs for Wheelchairs Act” alongside leaders of the Task Force on Aging and Families.

Under the bill:

• Medicare Advantage plans could not impose prior authorization, prescription or medical documentation requirements for repairs to CRT for plan years beginning on or after Jan. 1 following enactment.
• Prior authorization would be eliminated for the initial evaluation of medical necessity, or for replacement of CRT due to loss, irreparable damage, the end of its reasonable useful lifetime, or when the equipment has been in use for five years.

The bill would also align Medicare Advantage with traditional Medicare, where prior authorization is generally not required for wheelchair repairs. It defines CRT as including certain complex rehabilitative power wheelchairs, complex rehabilitative manual wheelchairs and certain manual wheelchairs, along with related accessories furnished with those items.

According to Pressley:

• More than 5.5 million people use wheelchairs in the United States, and regular maintenance and repairs are inevitable.
• More than 50% of wheelchairs break down within a six-month period, with average repair times of two to four weeks.
• Some wheelchair users wait six months or longer for repairs.

The issue is particularly pressing under Medicare Advantage, supporters say, because plans often require prior authorization for each repair, even after the chair itself has already been approved. That can add paperwork and delay for repairs ranging from routine maintenance to minor fixes.

“Right now, disabled people have to wait weeks to months to get approval to be able to repair their wheelchairs and this keeps them from being able to have the freedom of mobility,” said Mia Ives-Rublee, senior director for the Disability Justice Initiative at American Progress. “The durable medical provider market continues to shrink due to the acquisitions of smaller local providers, making it difficult to obtain repair appointments, particularly in rural areas. This bill will make it easier for disabled people to get back to their everyday lives.” 

The bill is endorsed by a long list of disability, rehabilitation and assistive technology organizations, including United Spinal Association, the International Registry of Rehabilitation Technology Suppliers (iNRRTS), the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), the Clinician Task Force, the National Coalition for Assistive and Rehab Technology (NCART) and Paralyzed Veterans of America.

“All consumers have the right to quick repairs, and they should not have to wait 7-21 days for paperwork to be approved,” said Wayne Grau, executive director of NCART.