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MEDICARE CRITERIA FOR MOBILITY EQUIPMENT

By Dee Taylor

Older people and those with physical disabilities have been able to get Medicare coverage for mobility devices such as wheelchairs, walkers and scooters, which are necessary for use in their own homes. However, for those who need mobility devices for functioning "outside of the home," Medicare does not provide coverage.

Since the institution of Medicare's coverage nearly four decades ago, standards for mobility devices and other kinds of durable medical equipment advances have been made in three critical areas:

1. Improvements in design of mobility devices that allow people to participate more fully in their communities.
2. Widespread societal recognition that with appropriate accommodations many limitations on functioning can and should be lifted
3. Court decisions requiring that individuals with disabilities be provided with the necessary supports to live as independently as possible in their communities.

In a statement released May 6, 2005 Robert M. Hayes, President of the Medicare Rights Center, a national consumer's group, had this to say about the announcement about the new, national coverage criteria for mobility assistance equipment, including power wheelchairs and scooters. "The National coverage decision issued today on wheelchairs and other mobility devices by the Centers for Medicare and Medicaid Services maintains an antiquated and illegal policy that will keep tens of thousands of Americans in cruel and unnecessary isolation. That isolation will lead to greater illness, dependence and higher health care costs. Today's national coverage decision maintains a long obsolete Administration policy that pays 80 percent of the cost of a power wheelchair for a person with Medicare, who needs it to move from bedroom to kitchen. But it does not cover the person who requires the wheelchair to leave home for medical care, shopping or even employment. The policy imprisons people in their homes and is based on an outdated reading of the Medicare law."

Mr. Hayes continued, "It is now the 21st Century. Changes in technology, medicine and law require coverage of equipment that allows people with disabilities to have a productive life outside the four walls of their homes."

Comments on this sensitive subject is in the "Executive Summary" on the Medicare Rights Center's website for The Centers for Medicare and Medicare Services,' (CMS) stated, "Interpretation of Medicare's coverage standard prevents people from getting needed medical equipment to function within their communities. By contemporary medical and legal standards, the interpretation is unreasonable and quite likely unlawful. The Medicare statute neither specifies that durable medical equipment be exclusively for use in the patient's home nor does it bar consideration of equipment use outside the home. There is no indication of Congressional intent to support this limitation of coverage."

CMS does have both the authority and responsibility to interpret the Medicare statute to be consistent with historical developments in law, technology and social mores. The United States Supreme Court precedent holds that agencies are "charged with the administration of (a) statute in light of everyday realities." However, everyday realities have changed since Medicare was launched in 1965. Congress has enacted laws such as the Rehabilitation Act of 1973; the Americans Disabilities act of 1990 and the Ticket to Work and Work Improvements Incentives Act of 1999. They all reflect a bipartisan commitment that is also evident in judicial decisions.

Mr. Hayes in his statement went on to say, "It is time for the White House to intervene. President George W. Bush championed the Americans with Disabilities act (ADA) and has repeatedly said he too supports allowing maximum independence for people with disabilities. It is now apparent the CMS will not support a realistic and humane policy that will free thousands of people with disabilities to a fuller life in their communities without direction from the White House or the courts. Existing law, common sense, and common decency cry out to change a policy that sentences people with disabilities to needless isolation."

We need his help to give Americans with disabilities what they need to learn and develop skills, engage in productive work, make choices about their daily lives and be allowed to participate fully in our communities through their own mobility outside of their homes.

Note: The Medicare Rights Center (MRC) is the largest source of health care information and assistance in the United States. Founded in 1989, they help older adults and people with disabilities get high-quality, affordable health care. See their Website: www.medicarerights.org or if you have questions call: 212-204-6219.

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Last Updated on May 21, 2005

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