Congress Asks HHS to Modify Medicare’s “In the Home” Restriction in order to Improve Access to the Community for People with Disabilities

[Washington, D.C.] – Earlier this week, a bi-partisan “Dear Colleague” letter was circulated in the House of Representatives by Congressmen Jim Langevin (D-RI) and Charlie Bass (R-NH). The letter asks Members to sign a letter to Health and Human Services (HHS) Secretary Michael Leavitt, requesting modification of Medicare’s “in the home” restriction which confines coverage of mobility devices to only those that are necessary for use inside the patient’s home.

“It is past time to update this Medicare policy to meet the needs of people with disabilities,” stated Congressman Langevin. “The current coverage policy runs counter to the goals of encouraging people with disabilities to enter the workforce and be part of their communities. This sends a mixed message by denying individuals with disabilities the basic tools they need to achieve maximum independence and function.”

This letter follows the Centers for Medicare and Medicaid Services’ (CMS) recent release of final Medicare coverage criteria for wheelchairs and other mobility devices. Despite pressure from consumers, clinicians, and industry, CMS’ final decision failed to modify or repeal the “in the home” restriction.
“We were extremely disappointed that CMS chose to maintain the ‘in the home’ standard and release new criteria that does little to improve access to the community for people with disabilities,” stated Lee Page of the Paralyzed Veterans of America and ITEM Coalition Steering Committee. “We feel this letter from Congress will help convey to the Department the urgent nature of the problem that the ‘in the home’ restriction presents to people with disabilities.”
The “Dear Colleague” letter suggests that HHS has become overly restrictive in its interpretation of the statutory “in the home” language, originally meant to differentiate between durable medical equipment (DME) that was provided in a hospital or skilled nursing facility (and reimbursed under Medicare Part A), and DME that was for use outside of a institution and warranted separate reimbursement under Medicare Part B. The Congressmen state that the current interpretation runs counter to other government initiatives such as the “Ticket to Work” program and the New Freedom Initiative, which aim to increase independence and community integration for people with disabilities.

The letter to the Secretary requests that CMS modify its interpretation of the “in the home” language through the regulatory process to better suit the “real-life” needs of people with mobility impairments. The lawmakers go on to state that if the Administration concludes that it does not have the authority to take such actions, that it quickly inform Congress of such a decision so that Members may begin considering legislative alternatives.

“It is impossible to argue that an individual’s mobility-related needs end at their front door,” stated Peter Thomas of the ITEM Coalition Steering Committee, “and Congress is asking HHS to remedy a policy which reflects this antiquated way of thinking,”

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 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.

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