Harkin Decries ‘In the Home’ Policy, Calls for Change

WASHINGTON–Sen. Thomas Harkin, D-Iowa, called for the “in the
home” policy currently governing Medicare’s reimbursement of
wheelchairs to be changed because it does not reflect users’ needs
and hampers fulfillment of the goals of the Americans with
Disabilities Act, the American Association for Homecare
reported.

Speaking at a Washington briefing on disability policy issues
last week, Harkin, who chairs the Labor, Health and Human Services
and Education Subcommittee of the Senate Appropriations Committee,
said the ADA needs to be restored because the law has been
interpreted more narrowly than Congress originally intended.

“We need to review and reform Medicare policies from a
disability perspective,” Harkin said. “For example, how can we
expect the ADA’s goals to be fulfilled when the largest purchaser
of health care in this country, Medicare, pays only for wheelchairs
that are appropriate for use in a person’s home–giving no
consideration to the need for mobility in the community and in the
workplace? This so-called ‘in the home’ policy has got to be
changed.”

Sharon Hildebrandt, executive director of the National Coalition
for Assistive and Rehab Technology, applauded Harkin’s comment.

“It’s encouraging to hear Sen. Harkin say this,” Hildebrandt
said. “It is a critical issue for people with disabilities who need
wheeled mobility. In order to be fully functioning and meet their
potential, people with disabilities need to have access to their
communities. NCART is fully supportive of revising this onerous
interpretation of the Medicare law that restricts access.”

Cara Bachenheimer, vice president of government relations for
Elyria, Ohio-based Invacare, also thought Harkin’s comments were
encouraging. “CMS has an overly restrictive interpretation of the
law which effectively confines consumers to their homes, and limits
the ability of beneficiaries to obtain the most medically
appropriate device that enables the beneficiary to be an active
member of his or her community, ” she said.

Bachenheimer noted that two bills were introduced last year in
the House and Senate that would have repealed the section of the
law that CMS is interpreting as limiting coverage of mobility
devices to “in the home.”

In 2005, 34 senators and 70 representatives signed a letter to
HHS asking that the restriction be modified through the regulatory
process (see HomeCare, August 2006). The government
responded that legislation would be required to make the
appropriate changes, prompting introduction of the bills, but the
109th Congress adjourned without taking action.

Harkin was the chief sponsor of the ADA when it debuted in 1990.
His advocacy for the rights of the disabled goes back to his
childhood, when his 7-year-old brother Frank became deaf after
contracting spinal meningitis and then faced many barriers, both
physical and cultural. That bothered Harkin, who has since won a
reputation as a champion of rights for those with
disabilities.