Congress looks for Leavitt's response to 'in-the-home'

Sunday, May 22, 2005

WASHINGTON -- Urged on by a consumer coalition, two congressmen have joined the industry's fight to eliminate Medicare's in-the-home restriction for durable medical equipment.

Rep. Charlie Bass, R-N.H., and Rep. Jim Langevin, D-R.I., are circulating a "Dear Colleague" letter to members of Congress explaining the background of the in-the-home debate. The letter calls the language restricting and "counter to important goals in the Administration's New Freedom Initiative and legislation such as the "Ticket to Work" program.

Medicare's new national coverage determination (NCD) for wheelchairs eliminated the controversial bed-or-chair-confined language. It did not, however, address the restriction which states that Medicare will pay for a wheelchair only if it is intended for use inside the home. The consumer-advocacy ITEM Coalition considers the restriction archaic and not in the best interest of beneficiaries, who typically need mobility equipment -- and other DME items -- inside and outside the home.

"Despite over 130 comments submitted to CMS in response to its draft NCD for mobility devices requesting reconsideration of the 'in the home' restriction, the final NCD did not address this critical issue," states the Dear Colleague letter.

CMS officials said during the NCD process that the in-the-home rule comes from the Medicare statute and that the NCD would not be an appropriate forum to address the issue.

The letter encourages other representatives to sign a letter addressed to HHS Sec. Michael Leavitt asking for a regulatory revision of the language.

"If your agency concludes that the in-the-home requirement cannot be addressed through the regulatory process, we request that you respond with such information and as quickly as possible, so that Congress may begin examining legislative alternatives," Sec. Leavitt's letter concludes.

"We are looking for an official response from Sec. Leavitt saying, 'Yes, we have the authority and we will work with the industry to address their concerns' or 'No we don't have the authority,' at which point we have him on record saying the only way to fix this is through a legislative procedure," said Seth Johnson, Pride Mobility's director of government affairs.

Johnson said Leavitt, in his new roles as HHS Secretary, has not made an official comment regarding this much-debated issue.

Along with Mike Leavitt's response, the industry is still anxiously awaiting a slew of mobility-related regulations, including the new CMN, the revised POV policy and the final face-to-face ruling.

"We have been monitoring that very closely but haven't been able to establish any solid time frame from Medicare about when that will be released," said Johnson. "It is still our understanding that they will be released together though."