Centers for Medicare and Medicaid Services (CMS) released new Medicare coverage criteria for wheelchairs and other mobility devices.
May, 2005
Please contact your lawmakers via the web at Right Wheelchair website.
Centers for Medicare and Medicaid Services (CMS) released new Medicare coverage criteria for wheelchairs and other mobility devices. Unfortunately, these new criteria fail to modify or repeal the discriminatory in the home restriction.
Please contact your lawmakers via the web at Right Wheelchair. Simply type in your zip code, edit the drafted letter in anyway you wish, and send the email.
Thank you for your help! Your actions will go a long way in changing this outdated and harmful restriction.
Please contact Emily Niederman at the ITEM Coalition (202) 349-4260 or Kim Ruff-Wilbert at United Spinal Association (202) 331-1002, with any questions.
Dear Colleague:
Over the past year, the Centers for Medicare and Medicaid Services (CMS) has been engaged in an initiative to reduce waste, fraud and abuse in the Medicare mobility device benefit (i.e. wheelchairs and "scooters"). This is a laudable goal that is worthy of support and should be continued in order to protect Medicare funds and resources.
On December 15, 2004, CMS announced the opening of a National Coverage Determination (NCD) process for mobility devices. The agency published a final NCD on May 5, 2005. While the new coverage decision recommended a widely applauded shift from the "bed or chair-confined" standard of coverage to more functionally-based criteria, the NCD failed to address one of the most problematic aspects of the Medicare benefit: the "in the home" criterion.
The "in the home" restriction under Medicare's mobility device benefit currently limits coverage to only those mobility devices that are reasonable and necessary within the patient's home. A patient who may not need a mobility device to function at home but needs such a device to access his or her community, work, school, physician's office, pharmacy, or place of worship, would not be eligible for a wheeled mobility device.
Congress originally intended this restriction to differentiate between mobility devices that were used within an institution such as a hospital or skilled nursing facility and those that were needed outside of an institution and, therefore, separately reimbursable under Medicare Part B.
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. The perpetuation of the "in the home" restriction runs counter to important goals established in the Administration's New Freedom Initiative and legislation such as the "Ticket to Work" program, which seeks to return people with disabilities back into the workforce and into communities. This sends a mixed message by denying individuals with disabilities the basic tools they need to achieve maximum function and independence.
We ask that you sign onto a letter (see reverse) to the Secretary of Health & Human Services asking for CMS to modify the "in the home" restriction through the regulatory process. Additionally, the letter requests that if the Secretary concludes that CMS cannot modify the "in the home" restriction through the regulatory process, that Congress be informed of such a decision as quickly as possible, so that legislative alternatives may be considered.
If you would like to sign on to this letter or have questions about this issue, please contact Amy Judge (Langevin) at 5-2735 or Alissa Southworth (Bass) at 5-5206.
Sincerely,
Charlie Bass Jim Langevin
MEMBER OF CONGRESS
Date_______
The Honorable Michael O. Leavitt
Secretary
Department of Health and Human Services
200 Independence Ave. SW
Washington, DC 20001Re: Reconsideration of the Medicare "In the home" Requirement on Wheelchair Coverage
Dear Secretary Leavitt,
The undersigned Members of Congress write to request that you modify the "in the home" requirement in Medicare's wheeled mobility benefit to improve community access for Medicare beneficiaries with mobility impairments.
We commend CMS for its dedication to reducing waste, fraud and abuse in the Medicare system, particularly under the mobility device benefit, and fully support your intention to protect precious Medicare funds and resources. Additionally, we commend the agency for recently taking on the task of creating a new and, hopefully, more appropriate Medicare coverage criteria for mobility devices. However, we are concerned that CMS' 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.
Recently CMS announced a final National Coverage Determination (NCD) for mobility assistance equipment (MAE) that fails to adequately address the concerns of beneficiaries and other parties with the "in the home" restriction.
In order to ensure that the "in the home" requirement does not act as a barrier to community participation for Medicare beneficiaries with disabilities and mobility impairments, we ask that you modify this requirement through the regulatory process. Additionally, 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.
We thank you for your consideration of this matter.
Sincerely,
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