Health
Durable Medical Equipment Used Outside the Home Should Be Covered by Medicare Part B
UCP and 21 other national disability organizations recently wrote Health and Human Services Secretary Thompson to urge an administrative change in the "in the patient's home" restriction on Medicare coverage of durable medical equipment (DME).
Congress has imposed no requirement that actual use of the DME be confined to a Medicare beneficiary's home, but HHS previously adopted a flawed interpretation of Medicare Part B law that prevents beneficiaries from receiving the types of durable medical equipment that would enable them to participate fully in community life.
As a result, Medicare beneficiaries often are not covered for medical equipment that can enable them to work and perform other activities outside of their homes. For example, while Medicare covers a standard manual wheelchair for a beneficiary with paraplegia, it will not cover a light-weight wheelchair even if that is necessary for the beneficiary to perform activities outside home.
These restrictions on access to DME are contrary to Congress' intent and discriminatory to persons with disabilities.
August 20, 2001
Secretary Tommy G. Thompson
Department of Health and Human Services
Room 615-F, Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, DC 20201
RE: New Freedom Initiative For the Disabled
Dear Secretary Thompson:
President George W. Bush and his Administration are to be commended for their commitment to "tearing down the barriers to quality that face many of the 54 million Americans with disabilities." The Administration's recent "New Freedom Initiative" includes the worthy goal of helping individuals with disabilities through "increasing access to assistive technologies, expanding educational opportunities, increasing the ability of Americans with disabilities to integrate into the workforce, and promoting increased access into daily community life."
In addition to the proposals outlined in the New Freedom Initiative, the Administration can take another valuable step that will have an immediate positive impact on an important segment of the disabled population -- Medicare eligible individuals with disabilities. Specifically, the Administration can and should modify a flawed interpretation adopted by prior Administrations that prevents disabled and elderly Medicare beneficiaries from receiving the types of durable medical equipment ("DME") that would enable them to fully participate in community life.
The Social Security Act (Section 1861(n)) requires that DME be used "in the patient's home," rather than a hospital or a skilled nursing facility, to qualify for Medicare Part B reimbursement. Congress' intent was to exclude Part B coverage of DME in an institutional setting. Congress did not otherwise impose a geographical limit on the use of DME (i.e., there is no requirement that actual use of the DME be confined to the four walls of the home).
Nevertheless, HCFA and the DME Regional Carriers have interpreted and applied the "in the patient's home" clause in an overly restrictive manner. Specifically, Medicare DME coverage has been limited to those items an individual demonstrates is needed within the home, rather than the DME needed to allow the individual to meet his or her daily responsibilities. As a result, persons with disabilities, young and old, have been denied Medicare coverage of the types of medical equipment that will enable them to attend school; go to work; meet their obligations as parents and heads of households -- e.g., to shop, attend meetings and activities at their children's schools; participate in religious services; and to otherwise be fully involved in their local communities and in American society.
For example, Medicare carriers will cover a standard manual wheelchair for an individual with paraplegia for use within the four walls of the home. However, the program will not even consider, let alone provide, the type of light-weight wheelchair this individual will need as a single parent with young children to be able to independently transfer into a car so she can take her children to school, participate in school activities, and accomplish the other community-based obligations required to supervise a household. Nor will the program consider or provide the type of light-weight wheelchair required by the same person to go to work, attend school necessary to improve her skills, attend religious services, or take part in other important activities, unless it is also medically necessary for use within the four walls of the home.
These restrictions on access to DME are contrary to Congress' intent and discriminatory to persons with disabilities.
- The intent of the "in the patient's home" clause was not to make elderly and disabled persons prisoners in their own homes. Rather, it was intended to distinguish between institutional and non-institutional settings.
- The "in the patient's home" interpretation also renders meaningless recent congressional initiatives to improve the lives of individuals with disabilities. One is the recently enacted statutory reform of the Medicare definition of "homebound." Congress will allow Medicare beneficiaries to access more community based activities without jeopardizing their access to Medicare home health care benefits. However, the "in the patient's home" interpretation will deny these individuals the DME they will need to access those activities.
- The "in the patient's home" interpretation also makes it difficult to impossible for individuals with disabilities to benefit from the Ticket to Work and Work Incentives Improvements Act, which is intended to promote the employment of individuals with disabilities by allowing them to maintain their health benefits. It is sadly ironic that Medicare, the benefit these individuals will be allowed to keep, if they go to work, will not provide the necessary DME for them to do so.
The "in the home" restriction on access to medical equipment also is contrary to long-standing standards of professional practice in rehabilitation. A proper assessment of an individual's need for equipment does not direct its exclusive focus to an individual's functioning within the home, but instead measures the level of an individual's functional capacities in regard to maintaining and improving the individual's independence in all activities of daily life.
It is unfair and counterproductive to prevent our Medicare beneficiaries from fully functioning in society through education, employment, religious worship, and other fundamental aspects of community life.
In keeping with the spirit of the New Freedom Initiative, we request that CMS (HCFA) make clear to the DMERCs through a Program Memorandum that DME that enables disabled and elderly Medicare beneficiaries to meet the needs arising in their daily activities, i.e., to participate in important community activities, is covered under the Medicare Part B benefit.
Thank you.
Sincerely,
CCD Health Task Force Members and Other National Disability Organizations
ADAPT
Adapted Physical Activity Council
American Academy of Physical Medicine and Rehabilitation
American Association for the Advancement of Orthotics and Prosthetics
American Association of University Affiliated Programs for Persons with Developmental Disabilities
American Medical Rehabilitation Providers Association
American Network of Community Options and Resources
American Occupational Therapy Association
American Physical Therapy Association - Private Practice Section
American Speech-Language-Hearing Association
Brian Injury Association
Center on Disability and Health
Easter Seals
National Association of Developmental Disabilities Councils
National Association of Protection and Advocacy Systems
National Association of Rehabilitation Agencies
National Council on Independent Living
National Multiple Sclerosis Society
Paralyzed Veterans of America
Rehabilitation Engineering and Assistive Technology Society of North America
Research Institute for Independent Living
United Cerebral Palsy Associations
cc: Jennifer C. Sheehy
Domestic Policy Council
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20502
Ann Phelps, Health Policy Advisor
Domestic Policy Council
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20502