ITEM Coalition Strongly Opposes Medicare Proposal to Deny Coverage for Vision Aid Technology

[Washington D.C.]  Today, the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition expressed strong disagreement with a proposed rule from the Centers for Medicare and Medicaid Services (CMS), under the Department of Health and Human Services (HHS), that would severely restrict access to and development of assistive technology for people with vision impairments.

On Monday, May 1, 2006, CMS issued a proposed rule that outlines a competitive bidding program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).  Within the regulation, CMS has chosen to include a section entitled "low vision aid exclusion."

The "low vision aid exclusion" segment of the regulation proposes that all devices, “irrespective of their size, form, or technological features that use one or more lens to aid vision or provide magnification of images for impaired vision” be excluded from Medicare coverage based on the statutory “eyeglass” exclusion.

According to Mark Richert, the Director of Public Policy for the American Foundation for the Blind, “CMS would be essentially stating that Medicare will not cover any device, regardless of cost, that could assist individuals with low vision from hand-held magnifiers to video monitors.”  Mr. Richert went on to state that “because Medicare plays such a large role in the assistive device market, this proposal could not only restrict access for those who currently have impaired vision, but threaten the development of any new technologies that could aid those who will experience such impairments in the future. We encourage CMS to take greater account of the impact this overly broad exclusion will have on an entire population of Medicare beneficiaries.”

The Medicare statue excludes coverage for “eyeglasses” except for one pair of “conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens.”  However, there has always been a level of ambiguity with regard to the Congressional intent of this language. The rule released on Monday is proposing to revise the Medicare regulations to state that the term “eyeglasses” is to be interpreted as any lens used for aiding sight and, thus, excluded from coverage.

"This proposal is just another example of the Medicare statute being interpreted in the most restrictive way possible when it comes to assistive technology and device coverage," stated Eva DuGoff of the Medicare Rights Center and ITEM Coalition Steering Committee Member.  "The agency continues to ignore any fluidity in the Medicare law and the result is a lack of access to important technology for people with disabilities.”

This proposal on low vision aids is likely motivated by a number of appeals over the past several years that challenge Medicare denials of video monitors and other such aids based on the eyeglass exclusion.  In one case, Currier v. Thompson, No. 04-94-B-W (D. Maine May 11, 2005), the U.S. District Court for the District of Maine found that a video monitor is not excluded from Medicare coverage based on the eyeglass exclusion and remanded the case back to the HHS Secretary to determine if a video monitor is considered under the Medicare benefit “durable medical equipment” or a “prosthetic device.”  However, this recently proposed regulation would invalidate this ruling.

 “Over the last several years we have witnessed the tightening of Medicare’s mobility device benefit as illustrated by the program’s increased commitment to the 'in the home' restriction and aversion to coverage of new mobility technology such as the iBOT Mobility System." stated Peter W. Thomas, ITEM Coalition Steering Committee Member.  “Now, it is clear that this is not a pattern unique to the mobility device benefit, but an approach that threatens the health and independence of all people with disabilities who depend on any assistive technology.” 

As Alaine Perry of the United Spinal Association states, “the impact of these restrictive coverage decisions is far-reaching.  Basically, Medicare is sending a message to all device manufactures, innovators and other stakeholders that investments in assistive technology for people with disabilities will not pay off.” 

The proposed rule can be accessed at http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/downloads/cms1270p_dme.pdf and comments on the rule are due by June 30, 2006. 

The ITEM Coalition was formed in 2003, and its 74 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 coverage of 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. 

###