Medicaid Cuts to Complex Rehabilitation Technology Threaten Access for Disability Community
By Don Clayback, NCART
Cuts to Illinois' Medicaid program are squeezing Complex Rehabilitation Technology (CRT) providers to the point where they are not be able to provide services to the nearly 4,000 Illinois residents who depend on the state to pay for CRT equipment.
Two Leading CRT Providers Unable to Participate in Medicaid
Illinois spends a small percentage of the overall Medicaid budget to help manage healthcare costs and maintain the quality of life for Medicaid beneficiaries with disabilities who use highly technical, individually configured wheelchairs. But in order to close the shortfall in revenue to meet spending obligations for Fiscal Year 2015, legislation was enacted (H.B. 317 and H.B. 318) which has a created a 16.75 percent cut for months of May and June, on top of previous cuts.
The consequence of these actions is a reimbursement rate for CRT providers for FY 2015 so low that it is cost-prohibitive for them to supply new CRT devices or to service and repair those currently in use. As a result, two of the leading CRT providers in Illinois are unable to participate in the Medicaid program at this point in time.
Cuts Hurt People with Severe Disabilities Most
Jill Sparacio is an occupational therapist in Chicago and has been in practice for more than 25 years. She works with children and adults with disabilities who require specialized wheelchairs and other adaptive equipment. "The important role that CRT plays can't be overstated. Are the savings in cuts to CRT going to be noticeable in terms of the state's budget compared to the detriment that the cuts will cost? Any savings that causes reductions in access will be more than offset by increased costs for resultant medical care, need for increased assistance within a person's home, as well as loss of income by putting a person's job in jeopardy."
Sparacio continued, "What's truly unfortunate is that many of the people impacted by these cuts have severe disabilities and have no voice or ability to advocate for themselves. The state needs to find a way to deal with the budget issues without hurting this frail population."
"The reimbursement rates in Illinois already are far from ideal but the current reductions in reimbursement rates are unworkable," Melissa Pickering, Executive Vice President of Payer Relations for Numotion. "Selling specialized equipment at less than the cost to make and maintain it is not a sustainable business model."
CRT vs DME: Not the Same Thing, Not Even Close
Reimbursement rates in Illinois are problematic for CRT providers because the state views this technology the same way it views Durable Medical Equipment (DME) like canes and walkers.
The Illinois Medicaid program does not spend a significant amount on CRT. Of the $10.5 billion spent on Medicaid in 2014, about $152 million was spent on Durable Medical Equipment (DME) and only about $15 million of that was spent on CRT. In fact, the state spends far more on diapers and wipes annually—nearly $50 million a year.
Complex wheelchairs are not diapers and they are not the same as other DME commodities. Wheelchairs used by a CRT consumer are significantly different than what is envisioned under the DME description and yet the State of Illinois treats them the same. The constant maintenance required on these chairs alone puts them in a different medical equipment category.
Call for Policy Change: Shield CRT from Further Reimbursement Rate Reductions
"The problems with CRT funding formulas in Illinois will never truly be resolved until a long-term solution is in place to prevent the kind of drastic cuts in reimbursement rates enacted this year," said Ed Curley, Vice President of Business Development and Payer Relations for National Seating & Mobility. "The equipment we provide to our customers is something they depend on every single day. All we are respectfully asking is for the state to recognize the specialized needs of people with severe disabilities and make needed changes to protect them and their families."
Complex Rehab Technology Providers in Illinois believe the long-term solution is to shield CRT from further rate reductions. They urge lawmakers to enact legislation, rules or other administrative actions which would separate CRT from the DME category and modernize the rate system. Additionally, further policy changes need to be considered to recognize the unique needs of the CRT consumer and the ability for providers to deliver the most current technology and the highest level of personal care and service given the costs involved.
More information and how to help resolve this issue will be available at the Abilities Expo Chicago at Access2CRT (Booth #208).
About the author:
Don Clayback is the Executive Director of the National Coalition for Assistive and Rehab Technology (NCART), an association of suppliers and manufacturers of Complex Rehab Technology (CRT) products and supporting services used by children and adults with significant disabilities and medical conditions. CRT products include medically necessary and individually configured manual and power wheelchairs, seating and positioning systems, and other adaptive equipment such as standing devices and gait trainers. This specialized equipment requires evaluation, configuration, fitting, adjustment, or programming to meet the individual's medical needs and maximize function and independence.
For more information, visit www.ncart.us.
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