ITEM Coalition Disappointed by CMS’ Perpetuation of “In the Home” Restriction; Says New Guidelines Will Not Improve Community Access

[Washington, D.C.] – The ITEM Coalition expressed disappointment today over the refusal of the Centers for Medicare and Medicaid Services (CMS) to address the “in the home” restriction through its National Coverage Determination (NCD) for mobility assistance equipment (MAE).

On Thursday, May 5, 2005, CMS released a final NCD for MAE (e.g. wheelchairs, power wheelchairs, and scooters), bringing closure to a process that has engaged consumers, clinicians and the mobility device industry for almost a year.

While the NCD implements a much applauded shift from the former “bed or chair” confined standard of coverage to a more functionally based standard, the NCD overall fails to recognize the beneficiary’s need to access his/her community.

“Unfortunately, CMS has missed an important opportunity to fix a benefit that has long-been broken,” stated Lee Page of the Paralyzed Veterans of American and ITEM Coalition Steering Committee Member. “By making no changes to the ‘in the home’ restriction and tying coverage to completion of indoor activities only, CMS has created a benefit that devalues the goals and potential of people with disabilities.”

The “in the home” restriction, (originally meant to define durable medical equipment (DME) as devices that were provided outside of a hospital or skilled nursing facility and, therefore, warranted separate reimbursement under Medicare Part B) is being interpreted by CMS to restrict coverage to only those mobility devices that are reasonable and necessary in the patient’s home. However, members of the ITEM Coalition recognize that a person’s need for mobility does not end at the front door.

“The ‘in the home’ restriction acts as an artificial barrier that stands in the way of appropriate wheelchair coverage policy and has far more to do with limiting utilization than it does with any conceivable clinical justification.,” stated Peter W. Thomas of the ITEM Coalition Steering Committee. “Perpetuation of this restriction defies the objective of community integration for people with disabilities as laid out in the New Freedom Initiative and validated by the Olmstead Supreme Court decision.”

Additionally, the new benefit requires that a mobility device assist a beneficiary in completing a “mobility-related activity of daily living (MRADL)” in order to be covered by Medicare. Contrary to recommendations by the disability community and the industry at an open door forum in February, CMS’s final NCD fails to expand MRADLs to include mobility itself, rather than “feeding, bathing, grooming, toileting and dressing;” all activities that take place within a person’s home.

“Mobility devices are used to travel from point A to point B, not just to position one’s self to brush one’s teeth or comb one’s hair,” stated Kimberly Ruff-Wilbert of the United Spinal Association and ITEM Coalition Steering Committee. “By failing to include mobility as an MRADL, CMS is creating a benefit that cannot be consistently or fairly applied.” Ruff-Wilbert continued.

While the release of this document officially ends the NCD process, the ITEM Coalition will continue its work to repeal Medicare’s “in the home” restriction.

“This was an issue long before the NCD process began and unfortunately it remains an issue at the close of the process. CMS seems to have completely ignored the extensive input of consumer and disability organizations,” stated Page. “ITEM Members will continue to pressure CMS to recognize that the ‘in the home’ restriction severely threatens the health and independence of people with disabilities.”

The final NCD can be accessed at www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=143.

The ITEM Coalition was formed in 2003, and its 75 member organizations include a diverse set of disability groups, aging organizations, consumer groups, labor organizations, voluntary health associations, and non-profit provider associations. The ITEM Coalition’s purpose is to raise awareness and build support for policies that improve access to assistive devices, technologies and related services for people with disabilities of all ages. For more information on the ITEM Coalition, please visit www.itemcoalition.org.

###