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

Thursday, June 30, 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., in May circulated a "Dear Colleague" letter to members of Congress explaining the background of the in-the-home debate. And when the letter closed in mid-June, it had nearly 40 co-signers in the House.
The letter, partly driven by the consumer-advocacy ITEM Coalition, 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.
A similar letter also began circulating in the Senate in mid June. Sen. Rick Santorum, R-Pa., and Sen. Bingaman, D-N.M originally signed that letter.
"We hope that this letter will convey to the Secretary and to CMS that this is a huge issue and an issue that should be dealt with and CMS and HHS should use their authority to change this restriction," said ITEM spokesperson Emily Niederman.
Medicare's new national coverage determination (NCD) for wheelchairs eliminated the controversial bed-or-chair-confined language. It did not, however, address the restriction that states that Medicare will pay for a wheelchair only if it is intended for use inside the home. ITEM 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 further asks Sec. Leavitt to report to Congress if he feels he does not have the authority to reinterpret the rule.
"Since we have never received a definitive answer from CMS as to whether they can modify this, it has left the consumer and advocacy groups in limbo not knowing who to work with to change this," said Niederman. "If nothing else, hopefully this letter will tell us who to turn to now."