For Complex Rehabilitation Technology (CRT) users, a wheelchair breakdown isn’t just an inconvenience. It means that daily life is on hold indefinitely. While most mobility equipment is designed to last five years, many of its key components fail well before that—and the consequences of these failures can leave CRT users stranded, resulting in lost income, missed appointments, and even contributing to serious health conditions. 

For CRT users, it’s not a question of if they’re going to experience a chair failure, but rather when. Research has shown that 64% of wheelchair users experience a failure in a given six-month period. Recent research has also shed light on the scope and impact of these failures—and what the data reveals is cause for attention.

Common Parts that Don’t Go the Distance

Mobility equipment is highly customized, often comprised of thousands of components. Just like a car or home appliance, the wear and tear caused by daily use takes its toll, sometimes leading to chair failure. 

For manual wheelchairs, research has shown that some of the parts that fail most frequently include: 

• Casters,
• Tires,
• Bearings,
• Armrests, and
• Footrests. 

Power chair users face failures in all the same areas with a few additional vulnerabilities, including: 

• Electronics,
• Batteries, and
• Motors/actuators. 

Recent research has shown that on average, these parts last about two years—less than half the expected five-year lifetime of the chair. This isn’t a quality issue, but due to the wear and tear of an active life. You’d never expect your car’s tires or brakes to last the entire lifetime of the vehicle, and CRT equipment that is used day in and day out to ensure independence and mobility is no different. 

Those with More Complex Mobility Needs Face a Higher Risk of Chair Failure

More complex mobility needs result in highly customized, complex mobility equipment—which means an increased number of parts and components that could potentially fail. 

CRT equipment is highly customized, meaning a CRT user with spinal muscular atrophy (SMA) needs a wheelchair that’s tailored to meet his or her individual needs, which may differ widely from those of other wheelchair users with different diagnoses. Customizations can range from custom seating systems that help with posture and pressure relief to advanced positioning like recline or tilt, alternate drive controls and more—but each addition adds to the complexity of the equipment and increases the number of components that could potentially fail. 

Research proves that point. In a 2021 study, researchers analyzed more than 6,000 caster failures across five wheelchair models, including manual and power chairs. The results? 

• Users of tilt-in-space manual chairs experienced high-risk failures twice as often as users of ultralightweight manual chairs. 
• Users of Group 3 and 4 power wheelchairs, often prescribed for CRT users with the most complex mobility needs, faced 15–26% more high-risk failures than Group 2 users. 

There Are Real Consequences to CRT Breakdowns

A 2018 study published in Archives of Physical Medicine and Rehabilitation found that when a breakdown had immediate consequences—such as being stranded, injured, or missing work or appointments—CRT users: 

• Reported higher pain levels and poorer perceived health,
• Were about 2 times more likely to be rehospitalized, and 
• Face a higher likelihood of developing pressure sores within 12 months. 

In addition to medical complications, breakdowns can also affect income, mental health and participation in work, family and community life. 

Why Preventive Maintenance Matters

It’s impossible to engineer mobility equipment with parts that will never fail—but research has shown that if preventive maintenance were a covered benefit, we could help more CRT users avoid catastrophic failure, injury, medical complications and many other adverse consequences. 

Currently, most insurance carriers don’t cover preventive maintenance for CRT equipment, so CRT users must wait for a part to fail before they can get it repaired. Studies have shown that regular maintenance can reduce accidents, lower long-term repair costs and improve outcomes.

Mobility equipment technology continues to evolve—but insurance provisions for preventive maintenance on that equipment has not. Learn more about why preventive maintenance should be a covered benefit and how you can advocate for change. Let’s get moving together to make a difference.

The post Like Cars, Wheelchairs Need Regular Maintenance appeared first on NSM — National Seating & Mobility.

Ready for a new wheelchair or need a repair to your mobility equipment? Navigating prior authorization requirements with your health insurance carrier can be one of the most confusing parts of the process.

At National Seating & Mobility (NSM), we understand the challenges and we want to help make the process a little less frustrating. In this article, we’ll help you understand prior authorization, the documentation requirements that are part of the new equipment or repair process and share helpful tips to make the process as smooth as possible. 

What Is Prior Authorization?

Prior authorization is basically asking your health insurance carrier or plan to agree to pay for new equipment or a repair to your existing equipment BEFORE anything is ordered. Be aware that some insurance carriers may not require prior authorization in some cases, so it’s important to learn what your health insurance carrier requires. 

The prior authorization process involves several steps and types of documentation, including: 

• A prescription for CRT equipment,
• A seating evaluation to determine the best CRT equipment for your needs,
• An equipment estimate that details the cost of the equipment you need, and 
• A Letter of Medical Necessity is a document that explains why specific medical equipment is essential for your health and well-being. 

Once you submit the required documentation to your health insurance carrier, they will review it and either approve or deny the request based on their specific guidelines for coverage. 

Detailing the Prior Authorization Process for New CRT Equipment

Requirement 1: Prescription for CRT Equipment

What It Is: A prescription from your physician stating that you need to be evaluated for a mobility device. You must have a prescription in order to set up a seating evaluation or request a repair. Most health plans require an in-person appointment with your physician that is focused on your mobility needs.

Who’s Responsible: Your doctor

Requirement 2: Seating Evaluation

What It Is: An assessment performed by a physical or occupational therapist or physiatrist and an Assistive Technology Professional (ATP) to evaluate your physical and functional needs to help determine the best mobility solutions for your needs and lifestyle. 

Who’s Responsible: Your therapists (physical or occupational) or physiatrist and ATP

Requirement 3: Equipment Quote

What It Is: After your seating evaluation, your CRT equipment supplier will create a detailed list of the recommended equipment and their associated costs.

Who’s Responsible: Your CRT supplier

Requirement 4: Letter of Medical Necessity (LMN)

What It Is: A formal letter or document that justifies your need for the prescribed mobility equipment, explaining how it addresses your specific condition, diagnosis and functional limitations. This is completed after your seating evaluation.

Who’s Responsible: Your physical or occupational therapist or physiatrist

Once the required information has been collected, it will be submitted to your insurance carrier for funding review and approval. Documents usually cannot be submitted independently, so know what your insurance provider requires and keep track of any missing documentation so you can follow up with the appropriate person. 

What About Repairs?

When it comes to repairs, many insurance carriers or health plans also require prior authorization before ordering parts to fix the problem. Other documentation requirements that health insurance carriers commonly require for repairs include: 

• An updated prescription or Statement of Continued Medical Necessity, 
• A repair assessment conducted by your wheelchair supplier, 
• A repair estimate, and 
• Proof of Original Purchase. 

How You Can Help

Prior authorization is a team effort! In most cases, your CRT supplier will collect and submit the required documentation to your insurance carrier, but your CRT supplier needs your help to ensure the process runs smoothly. Seek to understand your health insurance carrier’s prior authorization requirements and find ways to support the process. Here are a few ideas of how you can help. 

• Keep copies of all documentation for your own records. 
• Understand your insurance carrier’s prior authorization requirements for new equipment and repairs so you can anticipate documentation needs. 
• Know who to reach out to if a requirement is missing. Stay in contact with your funding specialist so you can quickly follow up on any missing items. 
• Be proactive. Request that your doctor, health care provider or therapists send information to your wheelchair provider as quickly as possible. As the insured person, follow up with your health insurance carrier once prior authorization has been submitted and ask that the decision be expedited. 
• Be prepared. Communicate with your wheelchair provider quickly if there are any updates or changes to your coverage. If you change insurance carriers during the process, understand that all of your information will have to be gathered and resubmitted to your new health insurance carrier, slowing down the process of getting new equipment or a repair. 

Have more questions about NSM’s service and repair process?

Find the answers in our helpful FAQ.

Take Action

Legislation aimed at removing or limiting prior authorization requirements for certain repairs is currently under consideration in several states. If passed, these reforms could significantly shorten the timeline for completing necessary repairs—often cutting delays from one to four weeks, depending on the insurance provider and their policies—ensuring CRT users maintain their independence and quality of life.

• Follow advocacy organizations like NCART, iNRRTS, AAHomecare and other advocates to stay up-to-date about ongoing efforts and learn what is happening in your state.
• Contact your state, local and federal lawmakers to share your story. This resource can help. 

The post Taking the Confusion Out of Prior Authorization appeared first on NSM — National Seating & Mobility.

For a child with mobility issues, Complex Rehabilitation Technology (CRT) equipment can open doors to greater mobility and independence for the entire family. But the process of finding the right mobility solution for your child can be a little overwhelming.

But don’t worry! The world of CRT is filled with tools to help your child thrive in and around your home, including car seats, strollers, wheelchairs, gait trainers, standers, and more. This guide will help you navigate your child’s CRT journey with confidence.

Start Early

If you suspect a delay in your child’s mobility of physical development, don’t wait! Talk to your pediatrician about your concerns and ask about a referral for physical or occupational therapy. Taking these steps early on will give you a better understanding of your child’s needs. 

Believe it or not, children as young as one year old can benefit from standers, and some children may begin exploring power mobility shortly after their first birthday. If your child isn’t meeting traditional milestones, like crawling or walking, it’s important to talk with your physician about your concerns as early as possible.

Find the Right Team

If you’re new to the world of CRT, you may not be familiar with the idea of a seating clinic. Seating and mobility clinics are specialized medical services where trained professionals will evaluate your child to determine the most appropriate mobility equipment to fit his or her needs and goals. 

At an established seating and mobility clinic, you’ll have access to occupational and physical therapists who specialize in body positioning, function and mobility as well as Assistive Technology Professionals (ATPs) from a CRT supplier who are trained experts on recommending and fitting CRT equipment. You may also have a chance to try out different types of equipment so you can better determine what works best for your child—and fits into your life, home and vehicle. 

Finding the right medical provider and physical therapist is the best place to start when building your child’s mobility care team. These professionals often already have an established relationship with a CRT supplier and can streamline the process by connecting you with a supplier in your area. However, if you live in a small or rural community, consider reaching out directly to a local CRT supplier for guidance. They can often help connect you with appropriate medical professionals in your area.

Partner with Your CRT Supplier

The world of CRT can be confusing and overwhelming, especially when you’re trying to make the best decisions for your child. Your CRT supplier is on your team and wants to provide solutions that make life easier for CRT users and their families. You have a shared goal: to help your child live his or her most independent life—and your CRT supplier has experience in providing CRT users with tailored mobility solutions that fit their lifestyles. If a particular mobility solution doesn’t live up to its potential or needs modifications, your CRT supplier is available to work with you and your child to find a solution that works.

Be Patient.

The process to get quality CRT equipment can take time. Here’s a general overview of what to expect. 

1. Referral: Your child’s doctor or therapist confirms your child would benefit from mobility equipment and recommends an evaluation. 
2. Scheduling the evaluation(s). Work with your therapist, CRT supplier or seating clinic to schedule a seating evaluation. 
3. Research recommended equipment: Do your homework after the evaluation to ensure the recommended mobility solution works for your child and fits your life (home, school, vehicle, travel, etc.) 
4. Documentation: While your CRT supplier will gather the needed documentation, you can help by knowing your health insurance carrier’s requirements and working with your provider to ensure documents are collected from different members of your child’s care team—doctor, therapist, you—in a timely manner. Learn more. 
5. Insurance Submission: Your CRT supplier will submit all required documentation to your health plan to obtain prior authorization. It will take time for a decision, sometimes up to 30 days. Additional time may be added if prior authorization is denied or deferred for more information. If there is a partial approval, your CRT supplier will help you determine your out-of-pocket responsibility. 
6. Ordering and Assembly: Once approved, your CRT supplier will order and assemble the CRT equipment for your child. 
7. Delivery and Fitting: Your CRT supplier will deliver the CRT equipment and make sure it fits your child. 
8. Follow Up: Set up a plan with your therapist for growth adjustments every six months to a year. Most pediatric CRT equipment is designed to last 3-5 years, and new equipment may be needed as your child’s needs and goals change as he or she matures. 

Find Your Community

As a parent navigating CRT for your child, you’re not alone! Stay connected to other parents, caregivers and CRT users by attending events like the Abilities Expo and joining online support groups. 

Navigating CRT decisions for your child can feel overwhelming, but it’s worth it so your child can experience his or her greatest levels of mobility and independence. Every child is different, but with early action, expert support and determination, your family can roll confidently into a future full of possibilities. 

The post Navigating CRT for Your Child appeared first on NSM — National Seating & Mobility.

While preventive care, such as bi-annual dental exams, preventive screenings and physical exams, is routinely covered by health insurance providers, preventive maintenance for CRT equipment is generally not covered. As a result, many CRT users feel they must wait for a part to fail before seeking a repair, which often leads to longer repair times, decreased mobility and independence, lost income, missing out on family and social events, and sometimes even contributes to medical complications.

How Would Coverage for Preventive Maintenance Help CRT Users? 

CRT equipment is highly customized and often comprised of thousands of components. Since CRT users use mobility equipment daily, the wear and tear adds up. Parts wear out or require frequent maintenance to keep the wheelchair working at optimal levels. Like routine oil changes or tire rotations on a car or scheduled tune-ups for household appliances, preventive maintenance for CRT equipment would benefit CRT users and their caregivers in several ways:

• Reducing catastrophic equipment failures by catching wear and tear before it contributes to additional damage or malfunctions.
• Ensuring frequent adjustments so that the chair is configured to a CRT user’s specific needs, including posture, alignment, pressure distribution, comfort and more. 
• Reducing health risks that can develop when a CRT user is immobile or incorrectly seated, such as pressure sores and musculoskeletal issues or falls and collisions caused by equipment failure.
• Preventing loss of mobility, allowing CRT users to work, spend time with friends and family and keep moving through their lives.
• Minimizing repair wait times since catastrophic equipment failures often lead to lengthy repairs and allows CRT users and caregivers to plan ahead for routine maintenance rather than deal with an emergency when a chair fails.

What Does Data Reveal about the Value of Preventive Maintenance for CRT Equipment? 

Researchers have conducted several studies that point to the value of preventive maintenance for CRT equipment in preventing injuries, accidents and medical complications. Chair failures can also affect income, mental health and participation in work, family and community life, which studies have noted as well. 

Here are a few highlights: 

• Research has shown that proactively checking up on equipment can lead to fewer accidents.
• While most CRT equipment is intended to have a five-year “useful life,” a number of components and parts routinely fail before that. These include casters, tires, bearings and more for manual chairs and electronics, batteries and motors for power chairs. 
• The more complex the mobility equipment, the higher the probability of a high-risk chair failure, often affecting CRT users with the most severe diagnoses and need for mobility solutions. 
• When a chair failure results in immediate consequences—being stranded, missing work or appointments—CRT users face a higher likelihood of developing pressure sores or being hospitalized. 

Learn more about the research that supports the value of preventive maintenance in ensuring CRT users can enjoy the highest levels of mobility and independence possible. 

Educate Yourself: Tennessee was the first state to enact legislation requiring its state Medicaid program to cover annual preventive maintenance for CRT equipment but legislation is under discussion or consideration in several states. Tennessee’s legislation, which took effect in July 2024, requires qualified technicians to perform all preventive maintenance services under manufacturer guidelines. Learn if legislation is being considered in your state. 

Did You Know You Can Make a Difference? 

As a CRT user, your experience can help legislators and health insurance carriers understand the value of coverage for preventive maintenance. You can help by: 

Research What’s Happening in Your State: Follow advocacy organizations like NCART, iNRRTS, AAHomecare and other advocates to stay up-to-date about ongoing efforts and learn what is happening in your state. 

Share Your Story: Lawmakers and health insurance providers may not fully understand the positive impact preventive maintenance could have on your daily life. By sharing your story and real examples of how equipment failures have impacted your life, work and health, you can help them understand the benefits covering preventive maintenance would provide. Find your elected officials. 

Make Your Voice Heard: In many ways, private healthcare insurance providers follow the example of Medicare and Medicaid. Call the Centers for Medicare and Medicaid Services (CMS) directly at 1-800-633-4227 to urge coverage of preventive maintenance. 

The post Did You Know: Preventive Maintenance appeared first on NSM — National Seating & Mobility.

Twenty-five years ago, NSM client Jerry Donovan made a promise—and he’s spent every day since keeping it.

Back then, Donovan worked for Boston Gas, fixing gas leaks throughout the city. In 1999, while driving his truck, his blood sugar suddenly dropped, causing a serious accident. The crash left Donovan—a Type 1 diabetic—with a T-6 spinal cord injury.

“In the ER, a priest came in, and I was an altar boy, so I knew why he was there,” Donovan recalls. “He was coming to give me my last rites. I made a promise to God: If you keep me alive, I promise I’ll do some good stuff.” 

It’s a promise he’s been living out for the past quarter century, as Donovan says, “for people in my position, for people going through traumatic life changes, for people who recover and for the ones who don’t.”

“People need people,” he said. “We pick each other back up when all the cards are down.” 

From Struggle to Service

Donvan’s road to recovery wasn’t easy. 

He credits Molly Sebo, a career physical therapist and clinical specialist—now executive director of SCI Boston, a chapter of the United Spinal Association—for helping him find a way forward. 

“I was a big, strong guy and a hardworking father, and the accident set me back like you can only imagine,” Donovan said. “Molly really helped me get my act together. I was so weak in the beginning that I couldn’t even push my chair up a little ramp. Things felt like they’d never change, and, if they did, never for the better. It can be very easy to become jaded.”

At first, Donovan struggled to adjust to life as a paraplegic. “I wasted a year not really listening,” he admits. But as he grew stronger, he realized he wanted to help others facing similar challenges. So, he became a peer mentor with SCI Boston, serving at Boston’s Spaulding Rehabilitation Hospital. 

“I would go into someone’s room and show them someone in a wheelchair with a smile on his face,” Donovan says. “I would tell them the truth: that this is going to be a difficult process, but with love and support, you can do this. 

“It’s a full-time job, plus overtime, being paralyzed and you really have to work hard to be the best person you can be with your disability,” he says. “Disability defines your character.” 

Building Community Through Golf

In 2011, Donovan took his mission further by co-founding Golf for All, a Massachusetts-based nonprofit that brings people of all abilities together on the golf course. Since then, Golf for All has organized numerous free golf clinics to help people with disabilities of all kinds enjoy the therapeutic and social benefits of golf. 

“Golf for All challenges people to get out and play nine holes with their families and friends,” Donovan says. “It really turns into a support group, and you end up having all these players out on the course who are just having fun.” 

A hockey player before his spinal cord injury, Donovan discovered adaptive golf while participating in an adaptive sports event at Spaulding Rehabilitation Hospital. Some of the skills he’d honed as a hockey player transferred right over to golf, and Donovan loved the sport from his first swing. 

“I only drive with one arm, and back when I first started playing golf, I was always trying to hit it harder,” he says. “But now I have a nice smooth stroke and it goes straight down the middle.” 

Expanding Access, Creating Joy

Donovan is committed to increasing access to the game of golf. In partnership with the Massachusetts Department of Conservation and Recreation (DCR), he helped acquire Paragolfers—adaptive devices that let wheelchair users stand and swing.

These specialized machines are available for rent at two Boston-area courses: Leo J. Martin Memorial Golf Course and Ponkapoag Golf Course.

“These machines are getting used,” Donovan says. “They’re not just for people who are paralyzed—they help people of all abilities get out on the course and have fun.”

One of Donovan’s favorite Golf for All programs is a driving range clinic for adults on the autism spectrum.

“I’ve found that adults with autism and kids with disabilities really enjoy being around others with similar abilities because no one picks on them,” he says. “We’re not playing nine holes, but they let everyone know they’ve been ‘playing golf.’ It’s about being together, outside, having fun. I love organizing and participating in it.”

Living Out His Promise

Today, Donovan continues to honor the vow he made in that ER more than two decades ago. 

“I’ve been helping people for 20 years now, and some of them have gotten better than me at golf,” he says with a laugh. “But you need that competitive fire. Keep working, keep trying to challenge yourself. Golf may not work for everyone, but find something you like to do and stay active.”  

The post A Promise Kept: Jerry Donovan’s Mission to Help Others Thrive appeared first on NSM — National Seating & Mobility.

Most private health insurance carriers and state Medicare or Medicaid programs do not cover transportation to wheelchair evaluation or repair appointments. Coverage that does exist varies widely by state and provider. If CRT appointments are covered under non-emergency medical transport (NEMT) provisions, health insurance carriers often set specific medical necessity requirements that CRT users must meet. In many cases, a healthcare provider must make the request for transportation and provide documentation that it is medically necessary. 

Educate Yourself: To learn more about what’s included or required in your state’s Medicaid program, please reach out to your state’s Department of Health and Human Services or comparable department. Find your state’s department here. If you’re covered by a private insurance carrier or Medicare, reach out to your insurance carrier for more information on what types of transportation may or may not be covered under your plan and the process for using those benefits to cover transportation to your CRT branch appointments.  

How Would Covering Transportation Help CRT Users? 

When it comes to CRT equipment, there’s no “one size fits all.” Each mobility device is highly customized to meet each individual user’s specific needs. A customized manual or power wheelchair can consist of a variety of individual components—all of which require frequent adjustments and repairs since CRT equipment is used on a daily basis. Because of this level of customization, many repairs need to be made by certified technicians. If CRT users can’t travel to their wheelchair provider for an appointment, the technician will come to them. 

Data tells us that 85% of repairs are completed in the home, and in-home repairs are always an option, especially for CRT users who are unable to travel due to their condition or other factors. But if you choose an in-branch appointment, there are benefits including:  

• In-branch repairs give technicians access to more parts than can be stocked on a van as well as specialized equipment/tools and the space needed to complete complicated repairs. 
• If an additional repair or maintenance need is discovered, the technician may be able to complete them without scheduling a follow-up appointment. 
• Technicians can see more CRT users in a day and serve them more quickly. 

If Medicaid, Medicare and private health insurance carriers covered wheelchair evaluation and repair appointments under their NEMT provisions, more CRT users would have access to their local branches for CRT-related appointments, protecting their health, preserving their independence and helping to keep their wheelchairs in optimal working condition.

Did You Know You Can Make a Difference? 

As a CRT user, your experience can help legislators and health insurance carriers see the need for change. Here’s how you can help: 

Pay It Forward: If you are able to travel to a local branch for a repair appointment, please consider doing so. This often results in a quicker repair timeline for you and allows technicians to prioritize CRT users who cannot travel due to diagnosis, condition or other factors with in-home appointments, ensuring everyone gets the help they need as quickly as possible. 

Share Your Story: Reach out to your state’s health and human services department and elected officials at both the state and federal level and explain how accessible transportation policies affect you. Find your elected officials. 

Make Your Voice Heard: Contact your health insurance carrier or Medicaid advisory groups. Call the Centers for Medicare and Medicaid Services (CMS) directly at 1-800-633-4227. 

The post Did You Know: Transportation Coverage appeared first on NSM — National Seating & Mobility.

Prior authorization is basically asking your health insurance carrier for permission before ordering the parts to complete a repair on CRT equipment that has previously been approved as medically necessary. The process involves submitting several documents and a variety of information to your insurance provider for approval. These often include: 

• A prescription,
• A repair evaluation; 
• An equipment or repair estimate, and 
• A Letter of Medical Necessity (LMN). 

Educate Yourself: Prior authorization requirements can differ depending on the health insurance carrier. Learn about your insurance carrier’s requirements and who is responsible for each step in the process so you know who to reach out to if documentation is missing or delayed. Also note, if you change health insurance carriers at any time during the repair process, you will have to start the process over with your new health insurance carrier as they likely have different prior authorization requirements.

How Would Changing the Prior Authorization Process Help CRT Users? 

Prior authorization creates bottlenecks in the process, delaying CRT users from getting the repair they need to achieve the level of independence and mobility they desire. Reforms to the prior authorization process and requirements would shorten the repair timeline and help CRT users keep moving, allowing them to enjoy daily activities and avoid additional health problems such as respiratory issues or pressure injuries that can develop from not having regular use of their customized mobility equipment.

A few ways prior authorization can slow down the process of making timely repairs include: 

• The authorization process is lengthy, often requiring several types of documentation to be completed by different members of the CRT user’s care team, including physicians, therapists and Assistive Technology Professionals (ATPs). Waiting for approvals from your health insurance carrier often makes up for nearly half of the repair timeline, adding one to four weeks to the process. 
• Authorization is required before ordering equipment or parts needed for a repair. It takes time to order, repair and deliver CRT equipment, and CRT providers cannot start the process until the health insurance carrier has approved. 
• If prior authorization is denied, you must appeal the decision, which often means submitting or resubmitting additional documentation and waiting for the health insurance carrier’s decision. 
• Even if your chair was previously approved and determined medically necessary, your health plan may require you to submit a prescription or Letter of Medical Necessity for most repairs—even replacing a battery. Learn more.

What Are Some Potential Solutions to Improve the Repair Timeline Process Related to Prior Authorization?

Reforms to prior authorization are needed to improve the CRT experience for users and their caregivers. These include: 

• Removing requirements for a prescription and a statement of medical necessity for repairs to equipment that has already been approved as medically necessary.
• Removing prior authorization or establishing a threshold up to $1,500 for minor repairs or frequently replaced parts to reduce unnecessary wait times and keep CRT users moving.  

Did You Know You Can Make a Difference? 

As a CRT user, your experience can help legislators and insurance carriers see the need for change. Legislation that seeks to remove or limit prior authorization is currently being considered in several states. You can help by: 

Research What’s Happening in Your State: Follow advocacy organizations like NCART, iNRRTS, AAHomecare and other advocates to stay up-to-date about ongoing efforts and learn what is happening in your state. If legislation is under consideration in your state, research and seek to understand how it would change the prior authorization process for you and your health insurance carrier. 

Share Your Story: Reach out to your insurance carrier and elected officials at both the state and federal level and explain how changes to prior authorization requirements would improve your daily life. Find your elected officials. 

Make Your Voice Heard: In many ways, private health insurance plans follow the example of Medicare and Medicaid. Call the Centers for Medicare and Medicaid Services (CMS) directly at 1-800-633-4227 to changes to prior authorization requirements. 

The post Did You Know: Prior Authorization appeared first on NSM — National Seating & Mobility.

When your complex rehabilitation technology (CRT) equipment breaks down, getting it repaired as quickly as possible is critical. Your chair is what keeps you moving through life. 

But CRT repairs take time. Many factors influence the repair timeline—from insurance documentation requirements to the review and approval process—and a lot of them are outside of the CRT user’s control. Even so, there are some proactive steps you can take to help keep the repair process moving as quickly as possible.

How Can You Help Speed Up the Repair Process?

Tip 1: Report the problem BEFORE it becomes catastrophic. 

Joystick not working properly? Notice a problem with your tire, footrest or battery? Report the issue to your CRT provider as soon as possible so that a small problem doesn’t become a full breakdown. Your wheelchair provider will set up an evaluation to determine what’s causing the problem. In some cases, a technician may be able to perform a remote evaluation, but if that is unsuccessful, you may need to schedule an in-branch or in-home evaluation appointment. 

Tip 2: Understand insurance requirements and approval times. 

Data tells us that almost 45% of the repair process is spent collecting documentation and waiting for insurance approvals, making this one of the most time-intensive parts of the process. Before parts can be ordered or repairs begin, most insurance carriers require prior authorization, which usually includes a repair evaluation and estimate as well as documentation of medical necessity and other requirements. 

You can help the process along by: 

• Understanding what documentation your insurance carrier requires. Learn more about common documentation requirements and seek to understand who is responsible for each, so you know who to contact if something is missing and can help urge them to quickly provide the required documents.  
• Reach out to your insurance carrier during the process to ensure the required documents have been received. 
• As the policyholder, request an expedited review of your documents, stressing that it is important that a decision be made quickly. 
• Keep copies of all the documentation you, your physician, or wheelchair provider have submitted to your insurance carrier and record when those documents were submitted.

Tip 3: Describe the problem as clearly as possible. 

When you reach out to your CRT provider for a repair evaluation appointment, strive to explain the issue as clearly as you can. State what part or parts are affected, what is or isn’t working, when the issue started, and if it’s gotten worse over time. 

Other advice: 

• Want your technician to see what you’re dealing with? Take a quick video when the issue occurs so that you can show them the problem and how it’s affecting your daily life. 
• Take photos of any damage or wear and tear that may help the technician diagnose what’s wrong with your CRT equipment.

Tip 4: Keep a maintenance log. 

Your CRT equipment needs to be in top working order to ensure you can achieve the highest level of mobility and independence you desire. Keep track of repairs and previous problems so you’re well informed about what’s been tried before and what hasn’t. Your records can help add additional information and details to those your technician and wheelchair provider have on file, helping them make an informed diagnosis as quickly as possible. 

Tip 5: Stay informed about your order. 

Seek to keep track of your order as it moves throughout the process. Many CRT providers, NSM included, offer online order tracking that helps you stay informed. If you are an NSM client, you’ll simply need to submit your first and last name and order ID at mynsmorder.com to track your order. If you don’t have your order ID, please email NSM’s customer care team at info@nsm-seating.com to retrieve that information. 

Keep in mind that CRT equipment is comprised of thousands of parts. While CRT suppliers keep a large supply of parts, they can’t feasibly stock every part that might need to be repaired. If a part needs to be ordered, it can add a little time to the process. By staying in touch and asking for updates, you help ensure the lines of communication stay open throughout the process. 

Take Action

Most insurance carriers require prior authorization for many (and sometimes, all) repairs. Often, this includes submitting a prescription and/or statement of medical necessity to prove you need the mobility equipment, even when the equipment was previously approved. 

Educate Yourself: Seek to understand your health plan’s prior authorization requirements and note how the prior authorization process slows down a needed repair. NSM completes more than 100,000 repairs each year and receives payer approval for more than 93% of them, meaning that prior authorization may not be necessary on most repairs. If prior authorization were removed for repairs under $1,500, it could help speed up the process by one to four weeks.

Connect with Advocacy Partners: Legislation is already under consideration in some states to remove prior authorization for some repairs, or if the mobility equipment has previously been approved by an insurance carrier as medically necessary. Connect with advocacy organizations like NCART, iNRRTS, AAHomecare, and other advocates to stay up-to-date about ongoing efforts and learn what is happening in your state.

Share Your Story: If legislation concerning the elimination of prior authorization is being considered in your state, reach out to your elected officials and share how this change would improve your daily life. 

The post Five Tips to Help Speed Up the Repair Process appeared first on NSM — National Seating & Mobility.

When your wheelchair breaks down, you just want to get it fixed as quickly as possible. A repair evaluation with your wheelchair provider at the local branch is often the fastest way to get the repair started, but getting there can be an issue. 

Since transportation to and from CRT-related appointments is not currently covered by most insurance providers, here are a few options to consider. Options may differ by location.

Paratransit

Paratransit services are designed specifically for people who cannot use regular public transit systems, such as individuals with disabilities or senior adults. Generally, paratransit offers door-to-door service, flexible routes and scheduling with accessible vehicles designed to accommodate mobility devices. Examples include Access-A-Ride in New York City or MetroAccess in Washington, D.C. Research your local transit system to see what paratransit options may be available in your area. You may need to meet specific criteria to qualify, and reservations may be required.

Transportation Voucher Programs

These programs offer vouchers or credits that can be used to pay for rides that cover public transit, rideshare services, taxis, paratransit or other transportation options. Programs may have eligibility requirements (sometimes based on income, disability, geographic location or other factors), and voucher programs may focus on different needs, such as medical transport, employment-related travel or general mobility. Examples include RideLink in San Diego County, California, or Dial-A-Ride, which is offered in various locations.

Wheelchair-Accessible Rideshares or Taxis

In larger cities, accessible taxis might be an option to get back and forth from your local wheelchair provider for an appointment. Some rideshare services provide wheelchair-accessible vehicle options, but be aware that these services may need to be scheduled in advance.

Local Nonprofits or Charities

In some locations, nonprofits, senior centers or disability organizations provide accessible transportation for medical appointments. Churches and other faith-based organizations may also be an option in your area.

Pay It Forward: If you can travel to your wheelchair provider’s local branch for an appointment, do so. This can not only facilitate the repair process for your chair, but will help technicians who travel to in-home appointments prioritize CRT users who cannot travel, ensuring everyone gets the help they need as quickly as possible.

Remote Evaluations: First Step in the Repair Process

More and more often, the first step in the repair process is setting up a remote evaluation with a technician to determine what might be wrong. Sometimes, the problem can be determined remotely, and, if not, the remote evaluation allows the technician to better prepare for an in-person evaluation. If you’re client of NSM, contact your local branch to learn more.

ADVOCACY ALERT

If more insurance providers covered transportation for CRT-related appointments, it would help keep more CRT users moving through life with the mobility solutions they need for greater independence and healthier lives. Here’s how you can help:

Educate Yourself: To learn more about what’s included or required by your state’s Medicaid program, please reach out to your state’s Department of Health and Human Services or comparable department. Find your state’s department here. If you’re covered by a private insurance provider or Medicare, reach out to your provider for more information on what types of transportation may or may not be covered under your plan.  

Share Your Story: Reach out to your state’s health and human services department and elected officials at both the state and federal level and explain how their accessible transportation policies affect you. Find your elected officials. 

Make Your Voice Heard: Contact your insurance provider or Medicaid advisory groups to reinforce the importance of accessible transportation for CRT services. Call the Centers for Medicare and Medicaid Services (CMS) directly at 1-800-633-4227. 

Engage with advocacy groups and advisory boards. Advocacy organizations such as the National Organization for Assistive and Rehab Technology (NCART), the ITEM Coalition and nonprofits or advocacy groups around specific diagnoses, like the Muscular Dystrophy Association (MDA) or United Spinal Association, can all be helpful in guiding you as you advocate for change.

The post What Are Your Transportation Options for Complex Rehabilitation Technology (CRT)-Related Appointments? appeared first on NSM — National Seating & Mobility.

Gearing up for your first evaluation for mobility equipment or want to make the most of your next appointment with your Assistive Technology Professional (ATP)? Consider these tips to help you prepare

Be Ready to Communicate Your Mobility Goals 

As the Complex Rehabilitation Technology (CRT) user, you need to be able to tell the story of what you want to accomplish — and that includes your personal and professional goals as well as how you like to spend your free time. If there’s something you want to be able to do or a particular mobility need you have, be prepared to talk to your ATP about that desire and why it’s important to you. The more clearly you or your caregiver can communicate that need or goal, the better. 

Be Able to Explain What’s Not Working

If something isn’t working quite right with your mobility equipment—from a faulty joystick or failing battery to a hard-to-maneuver manual chair—be prepared to communicate the problem in detail to your ATP. If you cannot communicate it yourself or don’t feel comfortable sharing about your personal circumstances, ask a caregiver or friend to accompany you and help you communicate your needs and desires. 

Review Your Insurance Coverage and Advocate for Yourself

As the insurance policy holder, you need to know and understand what your insurance provider covers and what it doesn’t as well as any documentation requirements they may have. By understanding what documentation is required to prove medical necessity or move the order forward, you can proactively advocate for yourself with your physician and therapy teams to help us obtain the necessary documents and forms. Once documentation has been submitted to your insurance provider, you can contact your provider to expedite your authorization. And—whether it’s your first evaluation or your 100th—be sure to bring your insurance card and other important information to the appointment. 

Do Your Research

Prior to your appointment or evaluation, take a look at the manufacturer’s website to learn more about what’s currently available and might fit your needs. While you may ultimately end up with a different mobility solution, having a solution in mind can help the ATP better understand what you want or need. Come to the appointment prepared to try out a new seating system or piece of equipment or to be assessed while operating the equipment or driving the chair. 

Ask Questions

Make a list of questions you want answered or information you need to understand during the appointment and go over it with your ATP. Ask to be educated on how your equipment works and what you can do to help maintain it and for documentation that supports these efforts. 

Seek to Understand the Process

Whether you’re ordering new equipment or getting a repair, understanding the nuances of the process can be helpful. Ask your ATP to explain the timeline or provide documentation that helps you better understand next steps. While you don’t need to be an expert on every detail, being familiar with the process can be helpful. 

Have more questions about NSM and mobility solutions? Check out these FAQs. 

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