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Commentary New Policy a Threat to Equal AccessBy David T. Williams The Centers for Medicare and Medicaid Services (CMS), a federal government agency, has promulgated regulations that may eventually force millions of Americans with disabilities back inside the “four walls of the home” that kept many out of sight, out of mind and out of the mainstream of American society. Section 1819(a)(1) of the Code of Federal Regulations defines durable medical equipment as any “…that is necessary to perform the activities of daily living within the four walls of the home.” CMS is using this language to justify restrictive and punitive payment policies and coverage guidelines for mobility devices (canes, crutches, walkers, other ambulatory aids, wheelchairs, scooters and power wheelchairs). Left unchallenged, these rules likely will result in people with disabilities being denied coverage for the rehab technology they need to fully participate in their communities. Congressmen Jim Langevin (D-R.I.) and Jim Ramstad (R-Minn.) have introduced H.R. 1809, the Medicare Independent Living Act of 2007, designed to amend Title XVII of the Social Security Act to exclude mobility devices from the restrictions of Section 1819(a)(1). To further that end, a grass-roots campaign has been launched by advocates and activists within the disability community, under the banner “We will ride… OUTSIDE!” The campaign, which includes clinicians, physicians, rehab providers and manufacturers, plans to send a message to Congress that the “four walls” restriction should be rescinded, along with any rules based on language in Section 1819(a)(1), such as those that became effective for Medicare beneficiaries on November 15th, 2006. The campaign’s Web site (www.wewillrideoutside.org) provides more information and resources. Now that these rules are in effect for the Medicare program, provisions in the Health Insurance Portability and Accountability Act (HIPPA) and the Medicare Modernization Act require that state Medicaid programs incorporate them in their operational guidelines by July 1st, 2007. Private, third-party insurance carriers and the Department of Veterans Affairs are scheduled to follow suit. The Medicaid program in Ohio and several private payers, including Aetna and Medical Mutual of Ohio, have already proposed using “in the home” to define what mobility aids they will pay for. CMS is ignoring the fact that our homes have more than four walls. Our “homes” include the walls within libraries, colleges and universities where we go to expand our minds. Our “homes” include the walls within churches, coffee shops, butcher shops, grocery stores, bookstores, cleaners, City Hall and so many other places. Our “homes” have sidewalks, parks, streets, ramps, thresholds, grassy surfaces and uneven garden walks. Our “homes” include places that we get to using public transportation and via our lift-equipped vans. Until July 26th, 1990, our “homes” existed largely in our minds. But on that day the president of the United States signed the Americans with Disabilities Act (ADA). At that moment, we were given the right to be full participants in every aspect of the life of our communities, and the “four walls of our homes” crumbled and became the “homes” we enjoy today. By using the “in the home” restriction, new policies exclude the highest functioning devices that enable us to move around in the community. The new rules fail to use functional criteria to assess an individual’s mobility needs. These new policies are not only a threat to our liberty, but a threat to our health and well-being. The wheelchairs and scooters available to us will be very slow and only be able to navigate 1½-inch-high obstacles and thresholds. This level of function is not sufficient for individuals with disabilities who are trying to return to work, go to school or access community services. Moreover, this level of function is inadequate to move about the community safely. The new policies were developed because CMS has been unable to control the growth in sales of scooters and low-end power wheelchairs. In an effort to identify and eliminate a few unscrupulous providers, CMS has resorted to a strategy that can be likened to “carpet bombing” the entire rehab technology industry. In so doing, the agency appears to be saying that people with disabilities are “acceptable collateral damage.” The time to act is now. People with mobility impairments, their advocates, friends, clinicians and rehab technology providers should write their representatives in Washington and encourage them to co-sponsor and support H.R. 1809. Correspondence with congressional representatives and senators should be addressed to: The Honorable (Name) U.S. House of Representatives, Washington DC 20515. Or The Honorable (Name of Senator), United States Senate, Washington DC 20510. Copies of the letters also should be sent to the secretary of the U.S. Department of Health and Human Services (Michael Leavitt) and to the administrator of CMS (both at 200 Independence Ave. S.W., Washington, D.C. 20201). By doing so, you will educate them about the importance of soliciting consumer input and advice before publishing new policies and regulations. Let them know that the current practices do not reach consumers at the grass-roots level and therefore are unacceptable. Tell Congress that our homes have more than four walls and to restrict coverage to technology that is only appropriate for use in the home is tantamount to denying people with mobility impairments access to the community. ******************************* David T. Williams is an author, freelance writer and a 30+ year veteran of the disability rights movement. His first book, Battling the Beast Within, is now available online at www.amazon.com |
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