H.R. 5371 to Create Path to Titanium, Carbon Fiber Upgrades

A new bill in the U.S. House of Representatives could provide a mechanism for Medicare beneficiaries who use ultralightweight wheelchairs to upgrade to a titanium or carbon fiber frame.

H.R. 5371 — introduced by Rep. John Joyce (R-Pa.) and cosponsored by Rep. Michelle Steel (R-Calif.) — is known as the Choices for Increased Mobility Act of 2023. Its text said it would “amend title XVIII of the Social Security Act to clarify payment rules for manual wheelchairs under part B of the Medicare program.”

In a joint Sept. 11 announcement ahead of this week’s CRT (Complex Rehab Technology) Virtual Fly-In, NCART and NRRTS said, “In the case of ultralightweight manual wheelchairs, upgrading to a titanium or carbon fiber base may offer increased medical benefits to the user, such as shock absorption and vibration dampening, which can increase sitting tolerance, support proper positioning, and decrease pain. For active users, the upgraded materials also provide increased durability that facilitates the performance of mobility-related activities of daily living (MRADLs) and maximizes the useful lifetime of the equipment.”

Medicare’s current reimbursement amounts for ultralightweight wheelchairs “do not cover the cost of upgrading to titanium and carbon fiber for enrollees who would benefit,” the NCART-NRRTS statement said. “Unfortunately, providers cannot afford to offer these upgrades at no charge, and currently, the only way to provide a custom manual wheelchair with these upgraded materials is to bill the equipment as ‘unassigned.’ This can only be done by non-participating Medicare providers and means that the CRT user must pay out of pocket for the entire wheelchair and then wait for partial reimbursement from Medicare. This system limits clinicians and providers, reduces patient choice, and creates inequity for those who would medically benefit from titanium or carbon fiber, but do not have the financial means to pay out of pocket.”

NCART and NRRTS pointed out that the new bill, which allows for code upgrades for Medicare-reimbursed titanium and carbon fiber wheelchairs, “would not result in any additional cost to the Medicare program. We believe that individuals should have the right to utilize their insurance benefits while still being able to optimize their equipment if they choose to do so.”

The organizations are asking for stakeholders to tell their Representatives about H.R. 5371 and encourage them to sign on as cosponsors. The new bill was one of the “asks” during the Sept. 13 Virtual Fly-In, which gave stakeholders the opportunity to speak with Members of Congress, Senators, and staffers about CRT access and policies.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at [email protected].

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