Congress: Modify in-the-home
WASHINGTON -- A rising tide of congressmen and senators is calling on CMS to modify the in-the-home restriction through the regulatory process, and if they cannot, to say why not as soon as possible.
More than 60 members of Congress and more than 20 senators have signed separate letters to Michael O. Leavitt, Secretary of the Department of Health and Human Services.
"We are concerned that CMS's current interpretation of the "in-the-home" requirement may continue to act as an inappropriate restriction in meeting the real-life mobility needs of Medicare beneficiaries with physical disabilities and mobility impairments," the House members stated in their letter.
In the wake of the recent National Coverage Determination for power mobility devices, voices within the HME industry bemoaned the fact that CMS did not address the in-the-home restriction in the NCD. The restriction keeps Medicare from paying for a power wheelchair unless it's intended for use inside the home.
CMS says the NCD is not the appropriate vehicle for addressing the NCD. But the 61 congressional signatories, led by Rep. Charlie Bass, R-N.H, and Rep. Jim Langevin, D-R.I., are asking CMS to modify it, or else.
"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 as quickly as possible, so that Congress may begin examining legislative alternatives," the letter states.
Rick Santorum, R-Pa., and Jeff Bingham, D-N.H., are the principal backers of the Senate's letter. Removing the in-the-home restriction is the number one priority on the 2005 policy agenda of the ITEM (Independence Through Enhancement of Medicare and Medicaid) Coalition, a consumer-led coalition of more than 70 organizations.
Fearful of a spike in utilization, the government has been reluctant to lift a restriction that would make it easier to get home medical equipment, especially power mobility equipment.
"It's possible that there would be somewhat of an increase in the number of wheelchairs prescribed under Medicare [if the in-the-home restriction was lifted]. But our idea is that the benefits would far outweigh the costs," said Emily Niederman, a staffer at ITEM. "Increasing independence will always be less costly."
The letters are evidence of a groundswell of awareness about the issue on Capitol Hill, and a clarion call for change within the Medicare program.
"CMS should have policies that enable seniors and people with disabilities to participate in society as much as possible," said Cara Bachenheimer, Invacare's vice president of government relations. "They should not impose artificial restrictions that essentially confine beneficiaries to their homes."