Langevin Tries Again on ‘In the Home’ Restriction

WASHINGTON — Rep. James Langevin, D-R.I., and 12 other House members have introduced the Medicare Independent Living Act of 2009 (H.R. 3184). The proposed legislation would eliminate Medicare’s “in the home” requirement for DME including power mobility devices.

Langevin introduced a similar measure in 2007, but no action was taken on the bill.

According to Langevin, the statutory in-the-home language was originally meant to define DME as devices that were provided outside of a hospital or skilled nursing facility, warranting separate reimbursement under Medicare Part B rather than Part A. Over time, however, CMS has interpreted that language as restricting coverage of mobility devices only to when a beneficiary has a medical need in the home.

That has made it difficult for “a significant number” of Medicare beneficiaries to qualify for the appropriate power wheelchair or other PMD, according to the bill.

In a 2005 interview with HomeCare, Langevin — the first quadriplegic elected to Congress — said he felt CMS had missed opportunities to clarify the issue both in its new national coverage determination on mobility and its interim final rule on power mobility devices issued that year. He subsequently co-authored a letter to then-HHS Secretary Michael Leavitt — signed by nearly 70 other congressmen — asking CMS to modify its in-the-home coverage restriction.

“There are people with great talents and skills who are stuck in their house as opposed to serving in Congress with me or being out there in the community realizing their potential and contributing their gifts and talents,” Langevin said at the time. “It’s a waste of talent and resources that we could use in the workforce.”

But CMS officials said the new policy was not the proper place to tackle the change and that the issue would be better addressed through legislation.

If Langevin’s recent measure becomes law, power wheelchairs and other mobility devices would be covered by Medicare if they are used “for the purpose of normal domestic, vocational or community activities,” even if the equipment would not be used primarily in the home.

“The need to have access to one’s physical environment through the use of an appropriate wheelchair or other mobility device, both inside and outside of the home, is critical to living independently, functioning in society and attaining a meaningful quality of life,” according to the bill.

The proposed legislation notes there are approximately 2.2 million wheelchair users in the U.S., with a significant portion of those users qualified for Medicare coverage either based on disability status or age.

H.R. 3184 has been referred to the House Energy and Commerce and Ways and Means committees.

Read the full text of the bill.