Bill Aims to Change ‘In the Home’ Restriction for Mobility Devices

WASHINGTON–Aimed at removing Medicare’s “in the home”
interpretation for coverage of mobility devices, the Medicare
Independent Living Act (H.R. 1809) has been introduced in the House
of Representatives.

Its authors said the bill would improve community access for
beneficiaries with mobility impairments by removing a restriction
that bases coverage of mobility devices solely on an individual’s
mobility needs inside the home.

Introduced by Reps. Jim Langevin, D-R.I–the first quadriplegic
elected to Congress–and Jim Ramstad, R-Minn., the bill has
bipartisan backing from 10 additional cosponsors.

“This legislation will help ensure that individuals with
disabilities have access to appropriate mobility devices and, in
turn, improved access to their communities,” Langevin said in a
press release. “It is time we remove this outdated restriction and
better align Medicare policies with the disability community’s goal
of independent living.”

According to the release, “the statutory ‘in the home’ language
was originally meant to define durable medical equipment as devices
that were provided outside of a hospital or skilled nursing
facility and, therefore, warranted separate reimbursement under
Medicare Part B, rather than Part A. However, over time, Medicare
has chosen to interpret this language in a way that restricts
coverage of mobility devices to only those that are reasonable and
necessary in the individual’s home.”

In a 2005 interview with HomeCare, Langevin said he
felt CMS had missed opportunities to clarify the issue both in a
new national coverage determination on mobility issued in May and
later that year in its interim final rule on power mobility
devices. Langevin subsequently co-authored a letter to HHS
Secretary Michael Leavitt–signed by nearly 70 other
congressmen–asking CMS to modify its in-home coverage restriction.
(See HomeCare, October 2005.) The lawmakers
said that if CMS decided the change couldn’t be accomplished under
the regulatory process, they would examine legislative options.

“We may very well have to introduce legislation to fix the
issue, which I’ve pledged to do,” Langevin said at the time. “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. It’s a waste of talent and resources that we
could use in the workforce.”

The proposed legislation was immediately lauded by members of
the ITEM (Independence Through Enhancement of Medicare and
Medicaid) Coalition, whose members include 74 disability and health
advocacy organizations.

“Perpetuation of the ‘in the home’ restriction contradicts
numerous other government initiatives such as the Americans with
Disabilities Act, the Olmstead Supreme Court decision, the
Ticket-to-Work Program and the New Freedom initiative–all aimed at
improved community access for individuals with disabilities,” said
Lee Page of the Paralyzed Veterans of America and a member of
ITEM’s steering committee. “An individual’s need for mobility does
not end at their front door, but rather extends to places such as
work, school and the community in general.”

The text of H.R. 1809 should be available shortly at http://thomas.loc.gov.

For more on the ITEM Coalition, see www.itemcoalition.org.