Mobility Management - DECEMBER 2023

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Defying The Odds

Creating Successful Assessments for Dependent Mobility

Marketplace: Manual Chairs & Accessories

The Impact of H.R. 5371 TITANIUM, CARBON FIBER & FREEDOM OF CHOICE

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editor’s note

CRT’s New Dawn

I

t’s time for editors to recap the year — the good and the bad. Part of that task — part of my responsibility — is to balance the year’s challenges (which are never in short supply) with good news, even if the “good” items are mere silver linings.

But 2023 was the year that the Centers for Medicare & Medicaid Services (CMS) agreed to Medicare coverage for power seat elevation on power wheelchairs for qualifying beneficiaries. Seat elevation coverage comes after decades of advocacy from the Complex Rehab Technology (CRT) industry.

And this was the year of H.R. 5371, the Choices for Increased Mobility Act, which re-establishes a path for Medicare beneficiaries to pay out of pocket to upgrade to a titanium or carbon fiber frame for their ultralightweight wheelchairs.

Our H.R. 5371 story (page 11) discusses how the bill could have a larger impact, since the ultimate theme of the bill — and of this overall advocacy effort — is to give wheelchair riders greater freedom of choice regarding wheelchair configurations and technological advances that could result in better functional and long-term outcomes.

So this bill feels different. H.R. 5371 isn’t the first time the CRT industry has turned to Congress for legislation regarding funding and policy. But this bill seems different because unlike previous legislative efforts (competitive bidding exemptions, for example), H.R. 5371 goes on offense.

Rather than being reactive and desperately defensive, H.R. 5371 is about wheelchair riders claiming the common-sense right to pay to upgrade to titanium or carbon fiber. This legislation wouldn’t cost the Medicare fund any additional money. Riders are saying, “Give us the right to make our own choices as consumers, at our own cost.”

As with any legislation or policy that goes into the books, the bill could set a precedent. One of the issues that some stakeholders have expressed about 5371 is that it provides a pathway to better outcomes for riders who can afford to upgrade. Those who can’t afford to upgrade would be left out — and that’s a significant number, given the perpetual problem of under- and unemployment among people with disabilities.

But the bill could be the first step toward expanding freedom of choice.

If clinicians and researchers can document better outcomes from custom configurations, for example, shouldn’t all wheelchair riders benefit?

While so many previous years were about building protective barricades, 2023 will be known as the year that CRT saw a new dawn. m

November/December 2023 mobilitymgmt.com

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Defying the Odds

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Creating Successful Assessments for Dependent Mobility

By Laurie Watanabe

T

he dependent mobility seating evaluation can be among the most challenging in Complex Rehab Technology (CRT), in part because many clients are limited in their ability to communicate with the seating team taking their measurements, choosing equipment, and doing the fittings.

Yet some seating professionals find working with people who have severe or profound disabilities to be immensely rewarding.

What do they do to get the most out of every evaluation, and the most out of every interaction with these clients?

Different Reasons for Dependent Mobility

Any conversation about dependent mobility — or any kind of CRT — needs to start with the disclaimer that every CRT client is unique. In fact, not every client who uses dependent mobility is unable to be independently mobile. Sometimes, dependent mobility is chosen for other reasons.

Jessica Presperin Pedersen, OTD, BA, OTR/L, ATP/SMS, is Director of Clinical Education North America for Sunrise Medical.

“The ultimate goal for anybody is to try to provide them with self-initiated movement,” she said. “But for some that’s not possible. It could be because of cognitive or physical deficits, but it also could be environmental constraints. As an example, in the Chicago area, sometimes I’ll have an individual that is not going to be able to have power because of where they live. Maybe the family can bump the manual mobility system up some stairs, but they can’t ever get a power chair up those stairs. They either don’t have the money for environmental modifications or don’t have the desire to deal with power.

“In that situation, we might choose a dependent tilt system for them.”

Angie Kiger, M.Ed., CTRS, ATP/SMS, is Senior Marketing Operations Manager, Permobil Americas. She remembered a client with “a high C-level spinal cord injury, and he’s having a whole conversation with me and is able to turn his head left. He said it was his choice to sit in a tilt-in-space [wheelchair]. He felt very self-conscious and thought more people would stare at him

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Defying the Odds

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if he was in a power chair than if he was in a tilt-in-space chair.”

Many other seating clients, however, use dependent mobility — such as manual tilt-in-space or stroller-style wheelchairs — because they are unable or thought to be unable to operate independent mobility.

Those clients may be limited in their ability to directly communicate their goals and preferences. Given those parameters, what strategies could be helpful for seating teams?

Remain Client-Centric

Regardless of whether or not the client communicates, the seating team can keep the client at the center of conversations. “[When] I had contract work at a residential facility and worked with the state of New Mexico for several years, we’d go to see individuals at different sites, and I would attempt to establish relationships with the people I was working with,” Pedersen said. “The relationship might be one of recognition, where they’d give a verbal or visual response to let me know they are comfortable to have me be near them.

“I always try to establish a connection using eye contact and see if there’s any way that they will respond to me. It is good to have that kind of connection because I’m going to be touching this person. I want to establish trust with them. So I always say something like, ‘Hi, I’m Jessica. I’m going to be working with you.’ If I’m molding them or doing something requiring touch with them, I’m constantly looking at them and making sure they’re going to be all right.”

Kiger remembered volunteering, as a middle-schooler, at a summer camp where she was assigned to support “the group for adults with significant intellectual impairments and physical disabilities. Some were verbal, some not.

“I was pretty intimidated when I first saw the campers I would be spending my summer with. However, the lead counselor in that room, a seasoned special education teacher, quickly initiated me into group. She was

amazing. Anytime someone walked into our camp room and said ‘hi’ only to the counselors, she would stop them and say, ‘You need to say hi to my campers, too.’”

said. “I need to see if they are adjusting their gaze or where they’re looking for a specific reason. Their vision impacts their posture, and that goes to the whole

Make sure their glasses are there, if they’re normally wearing glasses. I need to see if they are adjusting their gaze or where they’re looking for a specific reason. Angie Kiger Evaluate Them in Their Typical State

To best assess a client’s seating and mobility needs, it’s important to understand how they typically present and what they do in a typical day. But during her hospital tenure, Kiger said it was common to see non-verbal clients overly medicated by caregivers before arriving at seating clinic.

Kiger recalled caregivers saying, “‘We figured they’d be easier [to manage if medicated] because it’s not like they’re going choose what color wheels they want.’ So you’re going to bring them in extra medicated so they’re unconscious?

If they have the ability to know what’s going on around them, that’s not cool.”

Also, ask for everyday medical equipment and assistive technology to be brought to the seating evaluation.

“Make sure their glasses are there, if they’re normally wearing glasses,” Kiger

package of what I’m looking for, about their ASIS [anterior superior iliac spine].

“A lot of individuals that are dependent for mobility have other postural needs.

They have multiple splints, that’s not uncommon. So bring all of that stuff. We need to look at all of this.”

Give Them Every Opportunity to Engage

Pedersen noted that she keeps up a steady conversation during the evaluation.

“I think for people with severe and profound intellectual disabilities, even if I know in my heart that they may not respond to me, I always address them directly,” she said. “When I do that, I immediately gain a rapport with everybody around. I am also hoping that they begin to recognize my voice. They know that I am there to be with them.

Hopefully, when I touch them, there’s not that fear. I am going to take them

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out of their chair and have them against my body. So I want to establish some kind of trust with them. This may provide a comforting environment that may stop them from pulling into undesired postures that might be seen during stress.”

Pedersen said she talks through her actions so everyone understands her process. “Especially when I’m going to touch somebody, that’s an intrusion: I am in their space. I always try to engage and let them know where I’m going to be touching them and why.

“When I reach down and I’m underneath their ischial tuberosities, I’m talking to them and I’m talking to their caregivers as well. I’m saying, ‘Okay, my hands are going underneath you because I need to feel your bones’ so they know and the families know why I have my hands there.’”

Pedersen said she also gives clients every chance to participate — perhaps, for example, in choosing the chair’s color. “Facial expressions can provide a great deal of information. I could hold up two colors, and they might consistently look at one color. After that choice, hold up another color next to the one they just chose: ‘Which one do you like now?’ You bring up another color: ‘Which one do you like now?’

“I really try to engage as much as I can with them, and also rely on whoever knows them better, such as caregivers. When I contracted at the residential facility for children and adults with intellectual and developmental disabilities, I was able to learn their names and establish a relationship. They responded to me, such as laughing when I walked in the room. So they truly were a part of those evaluations.”

Don’t Underestimate What Clients Can Do

Kiger recalled working at a pediatric hospital in Washington, D.C., early in her career. “At the hospital, we served clients 0-21 years of age with a variety of diagnoses and disabilities.

The majority of the clients on our long-term care unit were

Defying the Odds significantly intellectually impaired, and some only responded to pain. Most of them had been discharged from therapy because they weren’t making any documented gains. I always made sure everyone received some sort of recreation services and socialization activities during the week. I made sure people would continue to go and interact with these kiddos.

“Sometimes, I would get so frustrated. I remember at one point, the TV wasn’t working in one of the patient rooms of six children on the long-term care unit. I vividly recall when I reported the TV to be fixed, an engineer said, ‘They’re not watching it, so why are you making it such a big deal?’

“And I said, ‘You don’t know what they are processing. You have no clue if they are, as you say, quote-unquote in there.’ I have had kids that have defied many odds.”

Asked why she has found it so rewarding to work with people who have profound disabilities, Pedersen explained, “A lot of reasons. There are ways of connecting, and it’s a feel-good type of thing when you have that connection. Either I get a laugh or a smile or just a relaxation against my body that says that they trust you.”

As for her goals for clients in dependent mobility, Pedersen said, “When I’m deciding on a dependent base with tilt and recline, I determine what postural support and angles they need to be able to tolerate the gravitational pull on their body.

I’m saying, “Okay, my hands are going underneath you because I need to feel your bones” so they know why I have my hands there. Jessica Pedersen The angles could change depending on the activities they are performing. They may need to be in a more upright position in order to swallow and get their food down, but then that position might change to a 45° angle when they’re digesting. I work with them and their caregivers to find out the best angles and what their tolerance is going to be.

“Other considerations are pressure distribution and involvement in participatory activities. The angles can be locked out if needed for safety. I once worked with a young adult who could not be tilted past 45° due to respiratory concerns. We locked the tilt so that a mistake past 45° would not occur.”

“I just have such a heart to make time to engage with any of our customers,” Kiger said. “I want to give them the time to hear their story and give them the voice to actually share it. Even if someone is non-verbal, I want to give them that time, that connection, that eye contact, that touch, just something.”

“That’s why the severity intrigues me, because our industry has so much to offer as far as enhancing comfort, physical abilities, function, and participation,” Pedersen said. “It’s just a fun, exciting field to be in.” m

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How the Bill About Ultralightweight Frames Could Impact Future Policy

By Laurie Watanabe

T

he Choices for Increased Mobility Act of 2023, H.R. 5371, clarifies Medicare payment rules for manual wheelchairs.

The bill amends the policy so Medicare payments will not be interpreted as including payment for titanium or carbon fiber used in the wheelchair base.

The bill itself was amended while in the House Energy & Commerce Committee, which called for two or more new HCPCS codes. Those codes would be “for the base of such a wheelchair depending on the construction material used in such base (with one such code that is used to identify such a base with titanium or carbon fiber materials and one code for such a base without such materials).”

It’s a brief bill, just over two pages long. But its potential ripple effects could change how wheeled mobility is selected, designed, and funded in the United States.

Current Medicare Coding & Funding

The Centers for Medicare & Medicaid Services (CMS) defines the K0005 code as an ultralightweight wheelchair that weighs

less than 30 lbs., has an adjustable rear axle position, and has a lifetime warranty on side frames and cross braces.

For qualifying beneficiaries, Medicare now pays for “a complete manual wheelchair base,” defined as “a complete frame; propulsion wheels; casters; brakes; a sling-seat seat pan or seat frame; a sling back or other seat back support; standard leg and footrests; armrests; and safety accessories (other than those separately billable in the Wheelchair Accessories Local Coverage Determination).

Though K0005 was established about 30 years ago, in 2016 CMS began to implement ultralightweight payments in a way that precluded beneficiaries from paying out of pocket to upgrade to a titanium or carbon fiber frame (see sidebar).

CMS’s reasoning: Existing reimbursement for the frame was meant to cover the cost of any material, including titanium or carbon fiber. Though titanium and carbon fiber were not being used for wheelchair frames when the K0005 code was created decades ago, CMS contends that its reimbursement is sufficient to cover materials that have only been used in wheelchair

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ATP Series construction relatively recently.

This interpretation effectively precludes consumers from paying privately to upgrade to a titanium or carbon fiber frame.

Consumers can pay the entire cost of the wheelchair up front and then file for partial Medicare reimbursement.

But consumer advocates say that paying for the entire wheelchair up front isn’t financially possible for many, if not most, ultralightweight riders.

Why Clinicians Opt for Upgraded Materials

are welded properly and manufactured properly, aluminum is going to reach a breaking point sooner than titanium and carbon fiber.”

Durability differences among the materials, Hamstra added, are closely linked to another hot topic: wheelchair repair.

“Truly, materials and quality and durability and the repair process [are related],” she explained. “If you’ve got these higher-quality materials — titanium and carbon fiber — those chairs should not be going in [for service] as often. They should not need as many repairs. So it’s going to clinically and medically just give [consumers] better access to whatever it is that they want to do because these chairs shouldn’t be in the shop as often.”

Sarah Leonard, PT, DPT, ATP, Clinical Education Manager for Sunrise Medical USA, noted that while the light weight of titanium and carbon fiber are frequently discussed in conversations about materials, weight isn’t everything.

“I think the conversation comes up a lot of the time that everyone’s trying to minimize weight,” Leonard said.

“Obviously, weight’s not the primary factor, and we’re going to tell you that configuration is paramount — that we want chairs optimally configured for that rider who really knows what their

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Seating clinicians argue that carbon fiber and titanium frames can provide better outcomes for at least some of their clients who use ultralightweight wheelchairs.

Christie Hamstra, PT, MSPT, DPT, ATP, is the Clinical Education Specialist for Motion Composites.

“There are functional differences of the material itself,” she said. “When you go into material science, you have aluminum, titanium and carbon fiber.

Aluminum is going to be heaviest because of the amount of material required to ensure adequate strength. It’s also going to be the least expensive.

“But [aluminum] is the most easily accessible for any manufacturer and for consumers, who can access it because of funding. However, if all the materials

The Promise of H.R. 5371 preference is and is currently trying to optimize their system. We’re talking about different materials and what those materials afford, whether it’s increased durability or vibration dampening.

“Certainly, we see from a manufacturing side that titanium and carbon fiber definitely afford the rider a bit more in that area. That’s not to say aluminum is not a great product. But certainly for me, it’s having that choice.

It’s the rider being able to decide with an advanced level of education: I know what my chair is doing for me. I know what I want it to do. I know the properties and materials that are available, and I’m making the educated decision to move forward.”

Thomas Halka, MOT, OTR, ATP, is a Clinical Education Manager for Permobil who previously practiced at the Dallas Veterans Affairs Medical Center in the spinal cord injury unit.

“I think the functional advantage of the material is very closely related to the goals and lifestyle of the client,” Halka said. “For example, if a client really enjoys a lifestyle that is outdoors — where the chair may be subject to scenarios that result in high impacts or the chair may be in situations where it is not handled ‘gently’ — a titanium chair may be best suited. Titanium is one of the strongest metals on earth and may be a better material choice in very active, high-impact situations.

“Carbon fiber is also very lightweight and has a higher resistance to stress than titanium, but it may not hold up as well to situations of higher impact. How the carbon fiber is woven can be tailored to the specific load requirements of the chair, which could result in improved ride quality. Both materials offer an opportunity to use the technology of material to provide a lightweight wheelchair that can be used to accommodate the lifestyle of the rider.”

Understanding Materials’ Nuances

Having more options can be crucial for seating teams trying to optimize a wheelchair for a particular client.

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ATP Series For example, Hamstra noted, carbon fiber weaves vary from manufacturer to manufacturer. “That’s why it’s important for consumers, therapists, suppliers, and end users/riders to do their research on what is going to work for them,” she said.

“This is a customized piece of equipment. If you’re just buying it based off of a brochure or a Web site, it’s probably not going to be the best.”

“The strength-to-weight ratio of titanium is something we talk about, certainly,” Leonard said. “Then of course, we have the conversation of what are we trying to accomplish? Is it the ride itself? Is it the rolling dynamics? Is it folding and loading the product? What is that affording somebody? Typically, as you go into the different materials, you are going to minimize weight to a degree. That’s when that conversation comes in.

The Promise of H.R. 5371 The Case for Custom Configuration

Jim Black, RGK’s Business Development Manager for North America, is a long-time ultralightweight wheelchair rider. He believes H.R. 5371 raises the larger question of consumers’ rights when it comes to their mobility.

“I think it’s a start for us when it comes to mobility and creating the right choice,” he said about the bill. “I know we’re talking more about materials, but I think materials is a small section of what we really need to look at… overall design. What I look for when I look for a chair is obviously, the durability. But also the configuration that I could achieve by the strength of the material, the welds, things like that that I can use to shape the frame to fit my body.

“So my [mobility] health and wellness are just like heart health or anything else you talk about when going to the doctor. I feel the same way being able to I know we’re talking more about materials, but I have a mobility device that I can utilize that will think materials is a small section of what we really eliminate or help in my daily activities without need to look at…overall design. Jim Black creating injuries.

“It’s fantastic that they’re allowing us choice if we can monetarily pay for something. It’s a huge value to “That’s why you see different materials being used for me to have something that’s going to be durable and to have different applications in this industry. You might have a titanium something that I feel confident in, but to also have something frame, but you might look at carbon fiber components. It’s the application in terms of lessening weight and increasing durability. that is not going to put me in a predicament where I can injure my body. What I mean by that is to achieve specific They’re looking at those different components and why you configuration heights to achieve better wheelchairs. That all would use one over the other. It’s about absolutely having pertains to choice, in my mind.” different opportunities and choosing what’s most appropriate for Black also stressed the importance not just of frame you under a given circumstance individual to you.” materials, but the ability to optimize the wheelchair’s overall configuration.

Carbon Fiber & Titanium Applications “I’m not trying to get political here,” he added. “But I think Hamstra emphasized the need to consider the clinical benefits this is a first step. It’s great, but I think overall design needs to of carbon fiber and titanium for all ultralightweight wheelchair be included in some type of new direction. I am still excited riders, not just active adults with paraplegia. that at least we can get a different material and utilize that “Let’s make sure that when we’re talking about active users material for what its values are and how it really enhances a and people that can benefit from titanium and carbon fiber, we rider’s life.” don’t forget the aging population and our pediatric population, So ideally, would H.R. 5371’s freedom of choice start the whole realm,” Hamstra said. conversations on other configurability options?

“We spend so much time in this industry talking about that “That is accurate, 100 percent,” Black said. “[For example] brand new para. But it’s also about that 3-year-old and that having a choice for wheels that are not just the standard K0005 8-year-old who are pushing around 100 percent of their body configuration, but being able to pay those upgrades as we move weight. It’s that 90-year-old, 97-lb. grandma who just wants forward because all of those things put together create a better to be able to get herself from her bedroom down to the dining mobility device.” room. And she can’t because she’s in a chair that’s six sizes too And Black emphasized the role that design plays in big, plus the material [isn’t optimal]. a wheelchair’s overall functional abilities and therefore “So I think we have to make sure that we don’t pigeon-hole consumer outcomes. this bill specifically just for [the most active riders]. Let’s pay for “People should understand it’s not the alloy or the material super lightweight [frames] for someone who has osteogenesis that creates the weight,” he said. “It’s the components that we imperfecta and may fracture. Or for someone who has Ehlersput on and the adjustments we put on the chair so we can have Danlos syndrome who dislocates continuously. Or the grandma who can barely push herself, but if we took 8 lbs. off of the chair a chair in that code. We add stuff to that, and that’s excluding the frame weight. You’re seeing chairs that are 40 lbs. when and moved that center of gravity forward, she might actually be you’re pushing them — they’re affecting your shoulders, your able to get herself from here to there and maintain her quality wrists, and your body, and that really starts affecting your life. of life.”

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.

ATP Series “Those are the areas that we need to really look at. How do we create access and better health for the body? Weight is a big part of it. So I didn’t want to underestimate the weight side of it, but the only way to take weight away is by design.”

Black is motivated by the injuries he’s seen in other wheelchair riders, and he is convinced that freedom of choice and configurability are the answers.

“I’ve seen kiddos [who have used wheelchairs] that have grown up that were very active,” he said. “And by the time they’re 20, 21, 22, they’re having pains that a 67-year-old individual would have, and it’s affecting their lives. So I think we should look at that. We should look at the value of not just the material, but what are the things we can do with design? Carbon fiber is a perfect example. Carbon fiber is an awesome material.

“But maybe that leads into how you fabricate something and even at a cheaper level have the same properties? That’s what technology is doing. And that’s what we can do as long as we can configure the chair and can get the chair the way we need it

The Promise of H.R. 5371 to be. And as long as we have a chair that we can build around the body. That is the key. We’re a long ways from that, and I’m excited that we’re going in the right direction. I can’t wait to see what comes out in the next few years. But we should keep on fighting this fight.”

“I think it is a fair to say that very few people, if any, choose to be in a manual wheelchair,” Halka said. “But in 2023, we have the materials and the technology to configure that wheelchair for each specific client, down to the smallest detail, with the goal of improving the quality of life and mobility for those we serve.

Giving a client the right to choose the material of their chair, especially when they have the financial means to do so, is the least that should be done.” m

Funding & H.R. 5371: Possible Policy Outcomes At press time, H.R. 5371 — the Choices for Increased Mobility Act of 2023

In 2016, CMS formally declared that titanium and carbon fiber were

— had been passed by the U.S. House Energy & Commerce Committee,

already being covered as K0005 frame materials, basically shutting down

with an amended section instructing the Centers for Medicare & Medicaid

the most direct, accessible path for an upgrade.

Since then, Medicare beneficiaries who want to upgrade to a titanium

wheelchairs, including a separate code for ones with titanium or carbon

or carbon fiber frame have been made to pay for the entire wheelchair

fiber.” If H.R. 5371 becomes law, it could set significant precedent for

up front, then file for Medicare reimbursement, minus the titanium or

future CRT policy.

carbon fiber cost. Paying for the entire wheelchair up front and all at once — rather than just paying for the upgrade

Remembering How We Got Here

— puts this option out of reach for many consumers.

Jim Stephenson, Senior Market Access Manager, Permobil Americas, is a CRT policy

Defining What H.R. 5371 Would Do

and funding veteran.

He explained that the stage for H.R. 5371

The bill now in the House would provide

was actually set more than 30 years ago,

an easier upgrade path — without costing

when the K0005 ultralightweight wheelchair

Medicare any additional reimbursement

code was introduced.

funds.

Though CMS announced the K0005 code

“Basically, what [the bill] would do is allow

in 1992, “It took them until December of 2016

folks to choose the frame, such as titanium,”

to say — [regarding] titanium and carbon

Stephenson said. “Right now, to get

fiber and any other type of special materials

titanium the provider has to bill [Medicare]

[the industry] may ever come up with — that

unassigned, and the consumer has to pay

CMS took all that into consideration when they created the K0005 code

the entire amount of money for the entire chair — seating, accessories,

back in 1992,” Stephenson said.

everything included.

That’s how and why CMS currently claims that titanium and carbon fiber

“H.R. 5371 would take that out of the equation, rather than billing it

are already included in the allowance of the K0005 code and therefore

unassigned and having Medicare reimbursing the beneficiary after the

ineligible to be separate upgrades.

fact.”

To substantiate CMS’s contention that the agency knew about titanium

Based on the information available as this story went to press,

and carbon fiber when creating the K0005 code, Stephenson said policy

Stephenson anticipated a two claim-line billing process, with claim line one

experts researched payer requests “from [approximately] 1992 to 1994

listing the “upgraded” product and claim line two listing the product for

or 1995, looking for any mention in the public record about titanium or

which the consumer qualifies.

carbon fiber or special materials.”

The search, Stephenson added, yielded zero results… suggesting there’s no evidence that CMS was deliberating titanium and carbon fiber frames at the time the agency was defining the K0005 code and what the

ILLUMINATION: ISTOCKPHOTO/DILOK KLAISATAPORN

Services (CMS) “to establish new HCPCS codes for ultralight manual

H.R. 5371, then, would give consumers the right to pay for a titanium or carbon fiber upgrade, if they choose.

“It’s a freedom of choice issue,” Stephenson said. “It’s restoring freedom of choice, essentially.”

code would include.

MOBILITY MANAGEMENT | mobilitymgmt.com

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P17

Funding H.R. 5371 Article &Category Could H.R. 5371 Impact the K0009 Code?

Article Header Adjustability — of seat and frame width and depth, seat frame angles,

Theoretically, passing H.R. 5371 could also make future CRT policy

seat-to-floor heights, front rigging frame angles, axle and wheel positions,

changes easier to achieve.

etc. — is a key theme of the paper.

“Any time we get something that’s favorable to us, it’s a precedent now,” Stephenson said. “Whether or not it’s a meaningful precedent

A New Day for CRT?

that we can leverage and use for other things down the road, I think that

While not every ultralightweight wheelchair user would want or need a

remains to be seen. But if we get this through, it certainly would open up

titanium or carbon fiber frame, Stephenson said H.R. 5371 is truly about a

additional conversations about some other things, to where we can lean

much more elementary subject.

on this and say, ‘It’s kind of the same thing as titanium and carbon fiber.’”

If H.R. 5371 becomes law, could it improve access to the K0009 code, currently defined as “Other manual wheelchair/base”?

Stephenson called it an interesting question.

“The K0009 code still exists,” he explained. It’s not gone. It’s just that you have to go through the code verification process in order to get a product assigned to it. The reach to get to a product coded as K0009 is a far stretch.”

In their January 2013 paper — Medicare K00009 Manual Wheelchair

“This is a freedom of choice, and it doesn’t cost [Medicare] anything to be able to give this to them,” he said. “That’s what it boils down to, and that’s how it’s being received within Congress, by our Representatives.”

While this is hardly the first time that CRT stakeholders have advocated for greater freedom and access, Stephenson said the conditions for change could be more favorable now than ever before.

“It’s like the light bulb is going on for everybody a lot more significantly this time around than it has in years past,” he said. “The perfect way to describe it is it’s progressive. This is my 20th year [in the industry], and

Manual — NCART and the Clinician Task Force argued to keep four

I’ve never seen anything like the responses we’re getting this time. It feels

types of CRT wheelchairs in the K0009 code: positioning tilt-in-space

different. Maybe people are finally starting to take serious consideration of

(<45°) manual wheelchairs; made-to-measure manual wheelchairs;

diversity inclusion. It hasn’t always been that way.

bariatric manual wheelchairs with special features; and standing manual wheelchairs.

The paper included letters from seating clinicians, as well as a presentation — all of which emphasized the importance of manual wheelchairs optimally configured and adjusted per each client.

“Now we’re fighting for [wheelchair riders’] right to have the normal choices of every other human being out there when they go to make any type of consumer transaction.”

Editor’s note: This is a developing issue. Check back for more Mobility Management coverage as H.R. 5371 progresses.

m

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manual wheelchair & accessories marketplace

Ziggo Pro

Bari+Max

Pediatric Wheelchair

The Ziggo Pro pediatric reclining wheelchair is designed to address the unique needs of children with disabilities. Offering a profound level of freedom, independence and comfort, the wheelchair boasts a lightweight design that folds compactly for easy transport. Its 108° reclining capability and many positioning options — including full back and neck support, elevating legrests, anti-tippers and quick-release wheels — ensure optimal support and mobility. The dual axle feature allows for easy adjustment of seat-to-floor height. Available in 12" and 14" seat widths, the Ziggo Pro is designed to facilitate movement indoors and outdoors.

The Dynarex Bari+Max HD Wheelchair with elevating legrest prioritizes safe and comfortable mobility for individuals needing extra support. With a 700-lb. weight capacity and a spacious 30" x 20" seat width, the wheelchair easily accommodates larger users. Crafted with a robust steel frame featuring dual cross-braces, this heavy-duty wheelchair provides heightened stability and exceptional durability. Its elevating legrests are equipped with padded calf pads and extra-wide footplates for optimal comfort and security. The wheelchair’s detachable desk arms with padded rests enhance its versatility.

The DynaRide Pediatric Wheelchair with Footrest is carefully crafted with children’s comfort and safety in mind. This premium wheelchair features a durable steel frame design for optimal strength and long-lasting performance. This precision-engineered wheelchair is equipped with swing-away adjustable footrests for added support and easy transfers. The padded desk arms are designed to flip back and out of the way for added versatility and convenience. The DynaRide Pediatric Wheelchair features height-adjustable push handles for easy customization and push-to-lock wheel locks for reliable stability.

Circle Specialty (718) 943-6452 www.circlespecialty.com

Dynarex (845) 365-8200 www.dynarex.com

Dynarex (845) 365-8200 www.dynarex.com

Convaid Trekker

Leggero Enzo

Fuze T50

The popular Convaid Trekker features a best-in-class, lightweight, compact folding design. It comes with a range of clinical and user-friendly options and two seating system sizes, 12" and 14", for early intervention users through teens up to 110 lbs. It offers up to 170° of adjustable recline and active tilt ranging from -5° to 45°, providing the option of an upright or reclined position for increased sitting tolerance. The Trekker Snuggle’s unique early-intervention design offers padded hip guides and an integrated headrest creating a cocooned fit to comfortably accommodate smaller users.

From the first concept to the final system, every aspect of the Leggero Enzo is designed to maximize aesthetics and performance.

The Enzo’s ultralightweight cast-aluminum frame and precise machining provide unparalleled rigidity in folding and rigid configurations. No attention to detail is lost on the Enzo. Customizable with options and accessories, the Enzo is the sleekest and most versatile transitional wheelchair on the market. Enzo has a weight capacity of 185 lbs., with seat depths of 11-20", seat widths of 12-18", a tilt angle of 8-14" and a hip angle of -5° to 45°.

The Fuze T50 offers comfort, stability, and versatility. It features a sleek aluminum frame with an infinitely adjustable tilt range of 50° and a unique center-of-gravity pivot point that is easy to set up and adjust. The Fuze T50 is designed for individuals who need pressure relief, routine repositioning, or have access needs. The short wheelbase makes for a small overall footprint and aids in maneuverability. Additional noteworthy options include the take-apart frame, adjustable frame width, ultra-narrow overall width package, transit tie-downs, 30° manual dynamic recline, and power tilt up to 350 lbs.

Etac (844) US-MOBILITY www.etac.us.com

Leggero (512) 756-4700 www.leggero.us

PDG Mobility (888) 858-4422 www.pdgmobility.com

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manual wheelchair & accessories marketplace

TiLite CR1

Raz-ART

Quickie Iris

With a transport weight of 9 lbs., the CR1 is the lightest-ever TiLite and redefines mobility with its user-first design and configurability. The aerodynamic tube profile and foam-filled core provide uncompromising performance and strength. A dual-angled front end enables users to get up to 2" closer to other surfaces for easier transfers. The bend in the frame’s downtube allows the casters to rotate back in space for improved access in tight areas. From specially designed caster bearings for vertical load application and weight reduction to new carbon fiber caster wheels and titanium reinforcement trim rings, the CR1 revolutionizes mobility.

The Raz-ART mobile shower commode chair utilizes a patented, dual-arc, orbital tilt system that allows for the smallest footprint and lowest tilt effort of any chair on the market. The unique, aluminum frame design provides two ranges of tool-less height adjustment (20-23" and 24-27") and a 40° tilt range. A patented tilt-locking system eliminates cable “looping,” which is prevalent on other designs. The Raz-ART features 40° of tilt range and is compatible with all standard Raz seats and most Raz accessories.

The Quickie IRIS Manual Tilt Wheelchair features up to 55° of Intelligent Rotation in Space technology, the broadest range of positioning and caregiver options, and numerous adjustments. The power tilt option gives the user more control over the position of their body in space and improves comfort by assisting with sitting tolerance. It provides more independence to participate in daily activities and to engage more with the world and others. The attendant control allows the caregiver to give control of the tilt function to the user. The IRIS now features a new standard weight capacity of 300 lbs. and a heavy-duty weight capacity of 400 lbs.

Permobil (800) 736-0925 https://hub.permobil.com/cr1

QUICKIE Nitrum Turn energy into motion with the award-winning QUICKIE Nitrum, designed to take riders further, faster, and longer.

Elevate your clients’ ride to new heights with Nitrum’s striking design, smart details, and unbeatable performance. Highly flexible and strong, each chair is made by hand in California and is unique, just like your clients.

Individually position feet, lower legs, and pelvis to optimize performance, improve handling, and maximize propulsion efficiency. The lightest in its class, the QUICKIE Nitrum features a minimalistic frame design, ovalized 7020 series aerospace aluminum, and hollow forged caster link tubes.

Sunrise Medical (800) 333-4000 www.sunrisemedical.com

Raz Designs Inc. (877) 720-5678 razdesigninc.com

Lateral Upper Body Supports (L.U.B.S.) The L.U.B.S. system is an innovative new approach to lateral support that can be mounted on any wheelchair backrest or to the wheelchair canes. Engineered from stainless steel and aluminum alloys, L.U.B.S. provides strong and secure 360° of pad positioning and contouring to ensure support is exactly where it needs to be. Free Form or solid pads are available in a variety of shapes and sizes.

Symmetric Designs (800) 537-1724 www.symmetric-designs.com

Sunrise Medical (800) 333-4000 www.sunrisemedical.com

Respira Back Supports Respira Back Supports are the lightest and coolest alloy backs on the market. Featuring passive and active ventilation, Respira Back Supports provide a healthy microclimate for the user. The Sport Trim features Stimulite padding and silver thread air mesh for odor control. The Comfort Trim features perforated, cooling gel-infused memory foam to dissipate heat and moisture right through the shell. Respira Back Supports are designed to breathe, engineered to perform.

Symmetric Designs (800) 537-1724 www.symmetric-designs.com

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