Senators Introduce Bill to Modify 'In the Home' Restriction
A bill that would eliminate the "in the home" restriction for Medicare coverage of mobility devices for individuals with expected long-term needs was put before the Senate on Monday, July 17. Senators Rick Santorum (R-Pa.), Jeff Bingaman (D-N.M.) and seven others introduced the Medicare Independent Living Act (S. 3677).
"I think the bill is a positive one," says Darren Jernigan, director of government affairs, Permobil Inc., Lebanon, Tenn. "I think the bill will have a tremendous amount of success if the word can get out what it's mean to do. And I believe that we can do that and it's within our grasp. We're going to have to have some sort of movement, maybe have some kind of separate Fly-In of sorts to get the word out. I think once it's done, once the message is across, that it makes total sense, and it will be in line with what Congress has tried to do in the past few years in regards to passing laws like the Americans with Disabilities Act (ADA) and the Air Carrier (Access) Act and the Fair Housing Act and a few other disability related laws that are meant to incorporate people into society and not segregate them within the four walls of their home. So, I'm excited."
The statutory "in the home" language — 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 currently interpreted by CMS to restrict coverage to only those mobility devices that are reasonable and necessary in the patient's home. Many individuals, however, are able to function without a mobility device inside their homes but need a device for community activities such as attending work, school, religious services, physician appointments and grocery shopping.
The Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition commended the senators, saying the bill would appropriate not only for daily activities inside beneficiaries' homes but outside their homes as well.
According to the ITEM Coalition, in July 2005, Senators Bingaman and Santorum spearheaded a bipartisan Congressional sign-on letter to the Secretary of Health and Human Services (HHS) asking that the department modify the "in the home" restriction to improve community access for people with disabilities. Despite the signatures of 34 senators on the letter, as well as 70 signatures from House members on a similar letter, the HHS Secretary responded by stating that the agency is confined by statutory language. As a result, the senators are now moving forward with a legislative fix.
Jernigan anticipates the criticism to the bill to be that it may "increase the amount of people that receive chairs, which I disagree with because I believe that medical necessity should not have geographic parameters tied to it — just like medical necessity shouldn't have age or race or gender." Jernigan says the current language violates a provision in the ADA and the bill provide clarification.
This article originally appeared in the July 2006 issue of HME Business.