In-the-home initiative gains traction

Sunday, July 23, 2006

WASHINGTON - Supporters of modifying Medicare's "antiquated" in-the-home restriction for mobility devices now have a leg to stand on. Two U.S. senators introduced a bill last week that, if passed, would make it easier for qualified beneficiaries to get wheelchairs and scooters for use inside and outside the home.

"This bill is a rallying point for us," said Emily Niederman, spokeswoman for the ITEM Coalition, a Washington-based consumer advocacy group. "We've long gone after an administrative strategy, but CMS has made it clear that they believe they're confined by statutory language."

Last year, the bill's sponsors, Sens. Jeff Bingaman, D-N.M., and Rick Santorum, R-Pa., sent a letter to the Department of Health and Human Services, requesting that the secretary modify the in-the-home restriction. The request, which had the backing of 34 senators and 70 representatives, was denied.

Realizing they had no other options, Bingaman and Santorum introduced the bi-partisan Medicare Independent Living Act of 2006, or S. 3677, to try and force CMS's hand through legislation.

Supporters of the bill must now drum up co-sponsors. Their first targets are those 34 senators who signed the letter to CMS. Supporters must also get a similar bill introduced in the House, which shouldn't prove too difficult, Niederman said.

"With 70 members of the House supporting our previous efforts, I would imagine there's someone interested in sponsoring a bill on that side," she said.

Things may not go as smoothly, however, when the Congressional Budget Office (CBO) announces the potential cost or "score" of the bill, industry sources said. In the past, CMS has been reluctant to modify the in-the-home restriction, fearing a spike in utilization.

But supporters of the bill maintain they're well poised to gain traction. They point out that the bill would apply only to mobility devices--not all DME. Moreover, S. 3677 could become a "showpiece bill" in an election year, said Simon Margolis, vice president for clinical and professional development for National Seating & Mobility.

"In-the-home could become a campaign issue in some states," he said. "That's a good thing. The concept of saying that old folks should only have equipment to use in their homes--that could become a major issue."