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.