Carving Out an Accessible Road to Washington: Advocacy Organizations Offer Beneficiaries Chance to Protest Medicare's ?In the Home' Rule


Technology has enabled people with disabilities to become active members of society. Visit a trade show, like the Abilities Expo, and take a look at the stunning revelations that show just how far we've come in the world of mobility. Every day innovations like eye-gaze technology, intelligent drive controls and smarter manual wheels enable people to explore their world in new ways. Despite all of these advancements, reimbursement for mobility devices is lagging far behind.

Take for example, the Centers for Medicare & Medicaid Services' (CMS) "in the home" restriction. CMS appears to have taken the phrase "home is where the heart is" a little too literally. Essentially, beneficiaries are awarded access only to the technology that allows them to function within the four walls of their homes. For many, the "in the home" restriction denies Medicare coverage for mobility devices necessary to maintain an active lifestyle outside the home — including equipment that makes going to the grocery store, to church, to work, to the park and to vote possible.

Join the Good Fight ITEM Coalition United Spinal Association

The industry has screamed loudly about CMS' interpretation of the home restriction, arguing that the language was meant to distinguish "home" from "hospital," not "home" from "front porch." Many advocates have called the policy discriminatory. The ruling negates policies and programs already in place, such as the Ticket to Work Program, the Olmstead Supreme Court Decision, the New Freedom Initiative and the Americans with Disabilities Act, according to the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition.

Advocates have campaigned hard for a legislative fix. A break in the clouds came in July with the introduction of a bill that would eliminate the "in the home" restriction for Medicare coverage of mobility devices for individuals with expected long-term needs. Senators Rick Santorum (R-Pa.), Jeff Bingaman (D-N.M.) and seven others introduced the Medicare Independent Living Act (S. 3677), which currently has been referred to the Committee on Finance for review. Other senators have since co-sponsored the bill, including Sen. Joe Lieberman (R-Conn.) and Sen. John Kerry (D-Mass.).

Though industry leaders have advocated for the issue, the burden to change the legislation has arrived at the doors of wheelchair users. Federal court rulings limit the right to challenge the rule to beneficiaries.

Fortunately, organizations have sprouted to help beneficiaries fight the good fight. The ITEM Coalition and the United Spinal Association are working hard to convince Washington to lift the rule.

A homepage link on the ITEM Coalition's Web site ( allows visitors to take action by signing up to receive e-mail alerts about ongoing efforts in Washington. A draft letter is also available for writing senators about the bill. Though the organization is based in Washington, D.C., the ITEM Coalition encourages nationwide involvement.

The United Spinal Association, which spearheads the Right Wheelchair Campaign to change the "in-the-home" interpretation, offers visitors the opportunity to join the campaign and also share and read personal stories about the rule's effects (

The fight continues, but with continued support from wheelchair users, it might just be a little easier.

This article originally appeared in the November 2006 issue of Mobility Management.

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