Stakeholder perceptions of policies, processes, and their implications in the provision of complex rehabilitation technologies: a qualitative study

For people with mobility impairments, timely access to an appropriate wheelchair can be essential to their health, safety, and function. This is especially important for individuals who use medically necessary, specialized, and customized mobility devices such as wheelchairs and adaptive seating systems, also known as complex rehabilitation technologies (CRT). Not everyone receives appropriate CRT, or in a timely manner. This study sought to understand stakeholder perspectives about CRT policies and processes, and their implications. As part of an ethnographic study, thirty-seven semi-structured interviews with twelve clients/caregivers, thirteen clinicians, and twelve CRT suppliers, ranging from 19 to 66 years old, were completed at an outpatient clinic in Colorado and beyond. Abductive analytical techniques and constant comparative analysis were used to identify primary themes and sub-themes. Three primary themes, and thirteen sub-themes were identified. Primary themes included Troublesome Policies, Onerous Processes, and Unintended Consequences. Participants had concerns about policies linking a beneficiary's eligibility to their diagnosis, limiting coverage to devices "suitable for use in the home," or requiring prior authorization for repairs. Insufficient funding for seat elevation, backup devices, and repair services were other concerns. Redundant paperwork, inconsistent policy interpretations, and payor practices were burdensome. Potential implications included a tendency to avoid denials, limited access, poor outcomes, and higher overall costs. Participants described Colorado Medicaid policies that may guide policy reforms. Policymakers should consider CRT policy changes to improve access for users and reduce costs for individuals, insurance companies, and the healthcare system.