[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3184 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3184

To amend title XVIII of the Social Security Act to eliminate the in the 
    home restriction for Medicare coverage of mobility devices for 
               individuals with expected long-term needs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 13, 2009

   Mr. Langevin (for himself, Mr. Young of Alaska, Mr. Kucinich, Mr. 
McGovern, Mr. Bishop of Georgia, Mr. Smith of New Jersey, Mr. Farr, Mr. 
Kennedy, Mr. Markey of Massachusetts, Mr. Holt, Mr. Carson of Indiana, 
 Mr. Olver, and Mr. Carnahan) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
   the Committee on Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to eliminate the in the 
    home restriction for Medicare coverage of mobility devices for 
               individuals with expected long-term needs.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Independent Living Act of 
2009''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--The Congress finds the following:
            (1) There are approximately 2,200,000 wheelchair users in 
        the United States according to the United States Census Bureau 
        of 2001.
            (2) A significant portion of these wheelchair users qualify 
        for coverage under the Medicare program, either based on 
        disability status or age.
            (3) Many of these Medicare beneficiaries live independently 
        in their own homes, alone or with other family members.
            (4) The ability of an individual with a mobility impairment 
        to move about one's physical environment through the use of a 
        wheelchair or other mobility device permits the performance of 
        activities of daily living, including caring for oneself, 
        living independently, performing household duties, caring for 
        family members, engaging in employment, attending school, 
        visiting medical facilities, participating in recreational and 
        community activities, attending religious services, and 
        performing civic duties.
            (5) For an individual with an expected long-term mobility 
        impairment (such as a disabling condition that is expected to 
        significantly limit mobility for twelve months or more), the 
        need to have access to one's physical environment through the 
        use of an appropriate wheelchair or other mobility device, both 
        inside and outside of the home, is critical to living 
        independently, functioning in society, and attaining a 
        meaningful quality of life.
            (6) In 1965, when the Medicare program was first enacted, 
        Congress recognized the importance of providing assistance to 
        individuals with mobility disabilities by expressly identifying 
        wheelchairs as a covered durable medical equipment benefit 
        under part B of the program when provided for use in the 
        patient's home. This language is widely believed to have been 
        drafted to establish a separate payment under part B for 
        wheelchairs provided outside of an institution (such as a 
        hospital) which would otherwise be paid under part A of the 
        program.
            (7) The Centers for Medicare & Medicaid Services (CMS), the 
        agency that administers the Medicare program, currently 
        interprets a provision in the Medicare statute--known as the 
        ``in the home requirement''--to prohibit coverage of 
        wheelchairs and other mobility devices if these devices are not 
        medically necessary for use in the beneficiary's home, denying 
        access to appropriate mobility devices for a significant number 
        of Medicare beneficiaries.
            (8) The current CMS interpretation of the in the home 
        requirement is inconsistent with Federal law in the following 
        respects:
                    (A) In enacting the Americans with Disabilities Act 
                of 1990 (Public Law 101-336), Congress found that ``The 
                Nation's proper goals regarding individuals with 
                disabilities are to assure equality of opportunity, 
                full participation, independent living, and economic 
                selfsufficiency for such individuals.''.
                    (B) The Rehabilitation Act of 1973 (Public Law 93-
                112) requires that Federal programs not discriminate 
                against individuals with disabilities, including 
                individuals with mobility impairments. However, under 
                the current CMS interpretation of the in the home 
                requirement, Medicare beneficiaries with long-term 
                mobility impairments cannot gain access to mobility 
                devices that facilitate their movement throughout the 
                community even when a particular device has been 
                determined to be medically necessary for this purpose. 
                The result of denying such access to appropriate 
                mobility devices is the unnecessary isolation of the 
                Medicare beneficiary, which is inconsistent with the 
                letter and spirit of the Rehabilitation Act of 1973 and 
                its regulations.
                    (C) The United States Supreme Court ruled in the 
                Olmstead decision (Olmstead v. L.C. ex. rel. Zimring, 
                527 U.S. 581 (1999)) that an individual with a 
                disability has the right to live in the most integrated 
                setting appropriate to meet the individual's needs. If 
                Medicare coverage policy does not take into 
                consideration the needs of individuals with mobility 
                impairments to function outside the four walls of their 
                homes, the right to live in the most integrated setting 
                is denied.
            (9) In 1965, and throughout the history of the Medicare 
        program, Congress has expected covered services to be provided 
        in accordance with current standards of medical practice and 
        professional clinical judgment as well as in accordance with 
        Federal law.
    (b) Purposes.--The purposes of this Act are as follows:
            (1) To bring CMS's coverage criteria for wheelchairs and 
        other mobility devices in line with contemporary standards of 
        medical practice and Federal law by correcting CMS's 
        restrictive interpretation of the in the home requirement 
        language in the Medicare statute.
            (2) To ensure that beneficiaries with expected long-term 
        mobility needs are not confined to the four walls of their 
        homes by wheelchairs and other mobility devices that are 
        inadequate to meet their needs both inside and outside of the 
        home.
            (3) To clarify that wheelchairs and other mobility devices 
        for beneficiaries with expected long-term mobility impairments 
        are covered under the Medicare program if they are used in 
        customary settings for the purpose of normal domestic, 
        vocational, or community activities.

SEC. 3. ELIMINATION OF IN THE HOME RESTRICTION FOR MEDICARE COVERAGE OF 
              MOBILITY DEVICES FOR INDIVIDUALS WITH EXPECTED LONG-TERM 
              NEEDS.

    (a) In General.--Section 1861(n) of the Social Security Act (42 
U.S.C. 1395x(n)) is amended by inserting ``or, in the case of a 
mobility device required by an individual with expected long-term need, 
used in customary settings for the purpose of normal domestic, 
vocational, or community activities'' after ``1819(a)(1))''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items furnished on or after the date of enactment of this Act.
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