[Congressional Record Volume 153, Number 144 (Wednesday, September 26, 2007)]
[Senate]
[Pages S12155-S12156]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Obama, Mr. Salazar, Ms. 
        Collins, and Mr. Lieberman):
  S. 2103. 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; to the Committee 
on Finance.
  Mr. BINGAMAN. Mr. President, I rise today with Senators Obama, 
Salazar, Collins, and Lieberman to introduce the Medicare Independent 
Living Act of 2007. This legislation would eliminate Medicare's ``in 
the home'' restriction for the coverage of mobility devices, including 
wheelchairs and scooters, for those with disabilities and expected 
long-term needs. This includes people with multiple sclerosis, 
paraplegia, osteoarthritis, and cerebrovascular disease that includes 
acute stroke and conditions like aneurysms.
  As currently interpreted by the Centers for Medicare and Medicaid 
Services, CMS, the ``in the home'' restriction only permits 
beneficiaries to obtain wheelchairs that are necessary for use inside 
the home. As a result, seriously disabled beneficiaries who would 
primarily utilize a wheelchair outside the home are prevented from 
receiving this critical and basic equipment through Medicare. For 
example, this restriction prevents beneficiaries from receiving 
wheelchairs to access their work, the community-at-large, place of 
worship, school, physician's offices, or pharmacies.
  On July 13, 2005, 34 senators wrote Secretary Leavitt asking the 
Department of Health and Human Services, or HHS, to modify the ``in the 
home'' requirement so as to ``improve community access for Medicare 
beneficiaries with mobility impairments.'' Unfortunately, CMS continues 
to impose the ``in the home'' restriction on Medicare beneficiaries in 
need of mobility devices.
  As the Medicare Rights Center in a report entitled ``Forced 
Isolation: Medicare's `In The home' Coverage Standards for 
Wheelchairs'' in March 2004 notes, ``This effectively disqualifies you 
from leaving your home without the assistance of others.''
  Furthermore, in a Kansas City Star article dated July 3, 2005, Mike 
Oxford with the National Council on Independent Living noted, ``You 
look at mobility assistance as a way to liberate yourself.'' He added 
that the restriction ``is just backward.''
  In fact, policies such as these are not only backward but directly 
contradict numerous initiatives aimed at increasing community 
integration of people with disabilities, including the Americans with 
Disabilities Act, the Ticket-to-Work Program, the New Freedom 
Initiative, and the Olmstead Supreme Court decision.
  According to the Medicare Rights Center update dated March 23, 2006, 
``This results in arbitrary denials. People with apartments too small 
for a power wheelchair are denied a device that could also get them 
down the street. Those in more spacious quarters get coverage, allowing 
them to scoot from room to room and to the grocery store. People who 
summon all their willpower and strength to hobble around a small 
apartment get no help for tasks that are beyond them and their front 
door.''
  In New Mexico, I have heard this complaint about the law repeatedly 
from our State's most vulnerable disabled and senior citizens. People 
argue the provision is being misinterpreted by the administration and 
results in Medicare beneficiaries being trapped in their home.
  The ITEM Coalition adds in a letter to CMS on this issue in November 
25, 2005, ``There continues to be no clinical basis for the `in the 
home' restriction and by asking treating practioners to document 
medical need only within the home setting, CMS is severely restricting 
patients from receiving the most appropriate devices to meet their 
mobility needs.''
  My legislation would clarify that this restriction does not apply to 
mobility devices, including wheelchairs, for people with disabilities 
in the Medicare Program. The language change is fairly simple and 
simply clarifies that the ``in the home'' restriction for durable 
medical equipment does not apply in the case of mobility devices needed 
by Medicare beneficiaries with expected long-term needs for use ``in 
customary settings such as normal domestic, vocational, and community 
activities.''
  This legislation is certainly not intended to discourage CMS from 
dedicating its resources to reducing waste, fraud, and abuse in the 
Medicare system, as those efforts are critical to ensuring that 
Medicare remains financially viable and strong in the future. However, 
it should be noted that neither Medicaid nor the Department of Veterans 
Affairs impose such ``in the home'' restrictions on mobility devices.
  Mr. President, I ask unanimous consent that the text of the bill and 
a letter sent to Secretary Leavitt be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2103

       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 2007''.

     SEC. 2. 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.
                                  ____

                                                    July 13, 2005.

               Senate Letter Opposing In Home Restriction

     Hon. Michael O. Leavitt,
     Secretary, Department of Health and Human Services, 
         Washington, DC.
       Dear Secretary Leavitt: The undersigned members 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

[[Page S12156]]

     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,
         Jeff Bingaman; Rick Santorum; John Kerry; Joseph I. 
           Lieberman; Barbara Mikulski; Maria Cantwell; Edward M. 
           Kennedy; Patty Murray; Evan Bayh; Mark Dayton; Jack 
           Reed; Johnny Isakson; Sam Brownback; Jon S. Corzine; 
           James M. Talent; Pat Roberts; Frank Lautenberg; James 
           M. Jeffords; Christopher S. Bond; Mike DeWine; Daniel 
           K. Akaka; Mary L. Landrieu; Debbie Stabenow; Charles E. 
           Schumer; Ron Wyden; Herb Kohl; Patrick J. Leahy; Arlen 
           Specter; Hillary Rodham Clinton; Christopher J. Dodd; 
           John McCain; Carl Levin; Tom Harkin; Olympia J. Snowe.

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