Sponsors (24)
The bill improves and speeds access to repairs for Medicare beneficiaries using complex rehabilitation technology and reduces paperwork, but it may raise costs for plans and taxpayers and create fraud and coverage-definition risks.
Medicare beneficiaries who use complex rehabilitation technology (CRT) can get necessary repairs faster because prior authorization is eliminated for repairs, improving timely access to functioning equipment and continuity of care.
Medicare beneficiaries and their providers face less paperwork and fewer documentation hurdles for CRT repairs, reducing administrative burden and potential out-of-pocket delays.
Medicare coverage rules are clarified by preserving prior authorization for initial medical necessity and certain replacements, maintaining safeguards to limit inappropriate new device acquisitions while easing repair access.
Medicare Advantage plans (and ultimately beneficiaries and taxpayers) may face higher repair costs, which could translate into higher premiums or reduced benefits over time.
Removing documentation requirements for CRT repairs could increase improper payments or fraud risk, potentially raising program costs borne by taxpayers.
A vague or placeholder definition of 'complex rehabilitation technology' may cause disputes over which devices qualify, creating implementation confusion and potential delays for beneficiaries and provider systems.
Based on analysis of 2 sections of legislative text.
Stops Medicare Advantage plans from requiring prior authorization, prescriptions, or extra documentation for repairs to complex rehabilitation technology wheelchairs, with limited exceptions.
Official title: To amend title XVIII of the Social Security Act to prohibit Medicare Advantage plans from imposing prior authorization with respect to repairs to complex rehabilitation technology.
Introduced June 18, 2026 by Ayanna Pressley · Last progress June 18, 2026
Prohibits Medicare Advantage plans from requiring prior authorization, prescription, or extra medical documentation for repairs of complex rehabilitation technology wheelchair components, starting with plan years that begin on or after the January 1 following enactment. It preserves prior authorization for initial medical necessity determinations and for replacement devices in certain circumstances (loss, irreparable damage, end of useful life, or after five years of use). The bill also adds a placeholder definition for “complex rehabilitation technology.”