Stakeholders see new bill as another vehicle to speed up wheelchair repairs

WASHINGTON – A new bill in the House of Representatives that would eliminate prior authorization requirements for wheelchair maintenance and repairs under Medicare Advantage aligns with a longstanding push by complex rehab technology (CRT) stakeholders who say the practice creates unnecessary delays for providers and patients.

Stakeholders have made the case to the Centers for Medicare & Medicaid Services (CMS) that Medicare Advantage plans should follow the same approach as traditional Medicare, which generally does not require prior authorization for wheelchair maintenance and repairs.

“We’ve asked CMS to enforce this with MA plans,” said Wayne Grau, executive director of NCART. “We feel like they have the regulatory authority to do it.”

Rep. Ayanna Pressley, D-Mass., introduced the Facilitating Access to Service and Timely Repairs for Wheelchairs Act in late June, 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 also would be prohibited for evaluations related to medical necessity and for the 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 industry has already seen the positive impact of removing prior authorization requirements for wheelchair repairs in certain Medicaid programs, including in Massachusetts, Grau said.

“It can take 20 days to do the paperwork,” he said. “This is compared to a provider getting a call for a dead battery and going out there, having the battery in the truck and just replacing the battery. Our providers are trying to be proactive, but this is a huge obstacle.”

While Grau acknowledges that newly introduced legislation often faces a lengthy path through Congress, he says the bill still serves an important purpose. Beyond its legislative prospects, it helps raise awareness of the issue and could increase pressure on CMS to address it.

“We support it and we’ll see what happens,” Grau said. “We need to bring it to their attention in as many ways as we can.”

• Related: California removes certain requirements for wheelchair repairs.