Medicare to Cowl Private Exoskeletons

LaTasha Washington, a 51-year-old T8 paraplegic from Detroit, is taking her first steps in 20 years with the help of a battery-powered exoskeleton. “I used to be taken with attempting the exoskeleton for the chance to train, stroll and hopefully enhance my bowel program,” says Washington, who sustained her spinal twine harm from a spinal tumor. “My first time within the gadget, I used to be actually nervous, however as soon as I received right into a rhythm, it was nice.”

Now, due to a brand new rule by the Facilities for Medicare & Medicaid Companies, others might have a better time following in her footsteps.

Shifting Out of the Clinic

CMS’ 2024 Residence Well being Rule that went into impact Jan. 1, 2024, now classifies exoskeletons throughout the brace profit class, which is reimbursed by Medicare.

In accordance with CMS, inclusion of exoskeletons within the present brace class will “expedite protection and fee for newer expertise and powered gadgets, probably offering quicker entry to those new well being care applied sciences for Medicare beneficiaries.”

The robotic braces are worn over a person’s clothes and supply powered movement for hips and knees, enabling these with SCI and different neurological circumstances to face upright and stroll. For years, FDA-approved exoskeletons have been round for scientific therapeutic use in rehabilitation facilities solely.

Washington, who makes use of the ReWalk Private 6.0 Exoskeleton, is among the many first within the U.S. to have the gadget lined below Medicare. She accomplished months of exoskeleton house coaching lately at DMC Rehabilitation Institute of Michigan and is trying ahead to taking her exoskeleton house.

“I’m so grateful. I by no means thought I’d have the ability to afford one thing like this. Not sitting on a regular basis and having the ability to stroll, it’s been a life-changer, a social changer and an emotional changer,” she says. “I’m excited to take it house and stroll up my avenue for the primary time. It’s a brand new stage of independence I’m trying ahead to.”

Ekso Bionics’ Indego Private and ReWalk’s Private 6.0 Exoskeleton are the one two exoskeletons accredited by the FDA for house use. Nonetheless, with value tags averaging over $100,000, they’re cost-prohibitive for the common SCI shopper, making Medicare protection an enormous win. “We’re very happy that CMS acknowledges the potential well being advantages that exoskeletons can have on the day by day lives of people with SCI,” says Ekso Bionics president Scott Davis.

Whereas a lot of the media protection of exoskeletons has targeted on their potential for on a regular basis mobility, analysis reveals that of their present kind, exoskeletons could also be most purposeful as an train gadget and for group social interplay. As an train gadget, there’s proof that common use of an exoskeleton can enhance a number of the secondary problems of paralysis, together with circulation issues, ache, decreased bowel and bladder operate, and decreased vary of movement.

“This milestone displays an acknowledgement by Medicare that ReWalk Private Exoskeleton is a medically crucial gadget, as supported by a physique of scientific proof, when prescribed for an eligible Medicare beneficiary with SCI,” says Larry Jasinski, CEO of Lifeward, previously ReWalk Robotics.

Price

CMS has proposed a fee stage of $94,617 for gadgets within the brace profit class. The beneficiary is liable for Medicare’s 20% copay. Washington had a supplemental plan that lined the total copayment. With out further insurance coverage, a person could be liable for the remaining out-of-pocket prices.

“We’re ready to supply our Ekso Indego Private on the proposed Medicare fee stage, so we will get this out to as many people [as] want it,” says Davis.

Eligibility

Lifeward and Ekso Bionics have related eligibility necessities for exoskeleton use. People have to be paraplegic, over the age of 18, with wholesome bone density, good tolerance for standing, and wonderful vary of movement on the hips, knees and ankles. A medical evaluation and radiologic imaging are additionally required. Eligible candidates should full 3-6 months of coaching with a companion at a licensed scientific web site to study primary and superior abilities earlier than they’ll take the exoskeleton house. You’ll find your nearest coaching middle on the Ekso and Lifeward web sites.

How To Get One

Inquisitive about an exoskeleton house unit? Step one is to speak together with your doctor and see in case you meet the eligibility necessities. There may be additionally lots of nice info on the Lifeward and Ekso web sites, the place you’ll be able to join with a care coordinator to stroll you thru the whole course of and reply your questions.