November 23, 2018 | Laura Power, 2018 AAPD Summer Intern

When I was applying to colleges, I was awarded a scholarship for writing an essay about how durable medical equipment (DME) affected my life. I have discovered that the definition of durable medical equipment I was using at the time was partially incorrect. My wheelchair, with its many supportive features, was not merely DME, but complex rehab technology (CRT). CRT and DME greatly differ. Medical insurance does not often cover aspects of CRT.

The implications of a related amendment, H.R. 3730, can be understood through comparison to existing legislation. The bill was created with a view to amending Title 18 of the Social Security Act (Medicare). The context, nuances, and implications of CRT and H.R. 3730 are worth exploring.

It is impossible to commence a thorough discussion of H.R. 3730 without considering the definitions of CRT or of the primary ways in which it differs from standard DME. According to the United Spinal Association’s materials, whereas DME is primarily used by beneficiaries who qualify for Medicare based on age, CRT is primarily used by Medicare and Medicaid recipients who are living with disabilities. Unlike standard DME, evaluation and maintenance of CRT requires a team of professionals including a physical therapist, an occupational therapist, and a certified rehab professional. In addition, customizing CRT to reflect individual needs requires a more thorough evaluation process. Finally, CRT quality standards are more rigorous than those of DME.

Currently, prices for standard durable medical equipment in certain parts of the country are determined by the Centers for Medicare and Medicaid Services’ (CMS) competitive bidding program. This means that DME and CRT providers compete to be accepted by CMS. The competitive bidding program is disadvantageous to the consumer because, in order to be eligible to furnish products to individuals who need them, companies are incentivized to offer the lowest price. This often means neglecting coverage of “accessories” or critical components needed by people using manual wheelchairs and related features and deeming them medically unnecessary. These components or features include electronically powered rear wheels, which allow individuals lacking upper body strength or endurance to propel themselves (Smart Drive), and cushions and tilting features designed to relieve pressure. Access to these features would promote independence and prevent hospitalization of manual wheelchair users, allowing them to easily live in the community. H.R. 3730 would exempt manual wheelchair accessories from the competitive bidding program and it would allow individuals to choose vendors in their price range and prohibit Medicare from fixing prices. Congressman Lee Zeldin sponsored H.R. 3730. It now has 120 cosponsors. When signed into law, this legislation would allow Medicare to better serve the disabled community.

H.R. 3730 accounts for the many differences between CRT and DME by acknowledging that prices should not be fixed on customized features thereby offering consumers a choice. If the consumer is offered options to find the technology that works best for them, they are likely to maintain their health. For these reasons H.R. 3730 is important and should be codified.

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Laura Power is a 2018 AAPD Summer Intern. She interned with the United Spinal Association.

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“Competitive Bidding Program.” Medicare.gov. The U.S. Centers for Medicare and Medicaid Services.
2018. Web. July 28, 2018.

“H.R.3730 – To amend title XVIII of the Social Security Act to provide for the non-application of Medicare
competitive acquisition rates to complex rehabilitative manual wheelchairs and accessories.” Congress.gov. Library of Congress. 2018. Web. July 28, 2018.
“2012 Position Paper.” United Spinal Association. United Spinal Association. 2018. Web. July 28, 2018.