I 

111TH CONGRESS 

1ST SESSION H. R. 3184 

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. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 13, 2009 

Mr. LANGEVIN (for himself, Mr. YOUNG of Alaska, Mr. KUCINICH, Mr. 

MCGOVERN, Mr. BISHOP of Georgia, Mr. SMITH of New Jersey, Mr. 

FARR, Mr. KENNEDY, Mr. MARKEY of Massachusetts, Mr. HOLT, Mr. 

CARSON of Indiana, Mr. OLVER, and Mr. CARNAHAN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Independent 

5 Living Act of 2009’’. 


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1 SEC. 2. FINDINGS AND PURPOSES. 

2 (a) FINDINGS.—The Congress finds the following: 

3 (1) There are approximately 2,200,000 wheel4 chair users in the United States according to the 

5 United States Census Bureau of 2001. 

6 (2) A significant portion of these wheelchair 

7 users qualify for coverage under the Medicare pro8 gram, either based on disability status or age. 

9 (3) Many of these Medicare beneficiaries live 

10 independently in their own homes, alone or with 

11 other family members. 

12 (4) The ability of an individual with a mobility 

13 impairment to move about one’s physical environ14 ment through the use of a wheelchair or other mobil15 ity device permits the performance of activities of 

16 daily living, including caring for oneself, living inde17 pendently, performing household duties, caring for 

18 family members, engaging in employment, attending 

19 school, visiting medical facilities, participating in 

20 recreational and community activities, attending reli21 gious services, and performing civic duties. 

22 (5) For an individual with an expected long23 term mobility impairment (such as a disabling condi24 tion that is expected to significantly limit mobility 

25 for twelve months or more), the need to have access 

26 to one’s physical environment through the use of an 


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1 appropriate wheelchair or other mobility device, both 

2 inside and outside of the home, is critical to living 

3 independently, functioning in society, and attaining 

4 a meaningful quality of life. 

5 (6) In 1965, when the Medicare program was 

6 first enacted, Congress recognized the importance of 

7 providing assistance to individuals with mobility dis8 abilities by expressly identifying wheelchairs as a 

9 covered durable medical equipment benefit under 

10 part B of the program when provided for use in the 

11 patient’s home. This language is widely believed to 

12 have been drafted to establish a separate payment 

13 under part B for wheelchairs provided outside of an 

14 institution (such as a hospital) which would other15 wise be paid under part A of the program. 

16 (7) The Centers for Medicare & Medicaid Serv17 ices (CMS), the agency that administers the Medi18 care program, currently interprets a provision in the 

19 Medicare statute—known as the ‘‘in the home re20 quirement’’—to prohibit coverage of wheelchairs and 

21 other mobility devices if these devices are not medi22 cally necessary for use in the beneficiary’s home, de23 nying access to appropriate mobility devices for a 

24 significant number of Medicare beneficiaries. 


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1 (8) The current CMS interpretation of the in 

2 the home requirement is inconsistent with Federal 

3 law in the following respects: 

4 (A) In enacting the Americans with Dis5 abilities Act of 1990 (Public Law 101–336), 

6 Congress found that ‘‘The Nation’s proper 

7 goals regarding individuals with disabilities are 

8 to assure equality of opportunity, full participa9 tion, independent living, and economic self10 sufficiency for such individuals.’’. 

11 (B) The Rehabilitation Act of 1973 (Public 

12 Law 93–112) requires that Federal programs 

13 not discriminate against individuals with dis14 abilities, including individuals with mobility im15 pairments. However, under the current CMS in16 terpretation of the in the home requirement, 

17 Medicare beneficiaries with long-term mobility 

18 impairments cannot gain access to mobility de19 vices that facilitate their movement throughout 

20 the community even when a particular device 

21 has been determined to be medically necessary 

22 for this purpose. The result of denying such ac23 cess to appropriate mobility devices is the un24 necessary isolation of the Medicare beneficiary, 

25 which is inconsistent with the letter and spirit 


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1 of the Rehabilitation Act of 1973 and its regu2 lations. 

3 (C) The United States Supreme Court 

4 ruled in the Olmstead decision (Olmstead v. 

5 L.C. ex. rel. Zimring, 527 U.S. 581 (1999)) 

6 that an individual with a disability has the right 

7 to live in the most integrated setting appro8 priate to meet the individual’s needs. If Medi9 care coverage policy does not take into consider10 ation the needs of individuals with mobility im11 pairments to function outside the four walls of 

12 their homes, the right to live in the most inte13 grated setting is denied. 

14 (9) In 1965, and throughout the history of the 

15 Medicare program, Congress has expected covered 

16 services to be provided in accordance with current 

17 standards of medical practice and professional clin18 ical judgment as well as in accordance with Federal 

19 law. 

20 (b) PURPOSES.—The purposes of this Act are as fol21 lows: 

22 (1) To bring CMS’s coverage criteria for wheel23 chairs and other mobility devices in line with con24 temporary standards of medical practice and Federal 

25 law by correcting CMS’s restrictive interpretation of 


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1 the in the home requirement language in the Medi2 care statute. 

3 (2) To ensure that beneficiaries with expected 

4 long-term mobility needs are not confined to the four 

5 walls of their homes by wheelchairs and other mobil6 ity devices that are inadequate to meet their needs 

7 both inside and outside of the home. 

8 (3) To clarify that wheelchairs and other mobil9 ity devices for beneficiaries with expected long-term 

10 mobility impairments are covered under the Medi11 care program if they are used in customary settings 

12 for the purpose of normal domestic, vocational, or 

13 community activities. 

14 SEC. 3. ELIMINATION OF IN THE HOME RESTRICTION FOR 

15 MEDICARE COVERAGE OF MOBILITY DEVICES 

16 FOR INDIVIDUALS WITH EXPECTED LONG17 TERM NEEDS. 

18 (a) IN GENERAL.—Section 1861(n) of the Social Se19 curity Act (42 U.S.C. 1395x(n)) is amended by inserting 

20 ‘‘or, in the case of a mobility device required by an indi21 vidual with expected long-term need, used in customary 

22 settings for the purpose of normal domestic, vocational, 

23 or community activities’’ after ‘‘1819(a)(1))’’. 


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1 (b) EFFECTIVE DATE.—The amendment made by 

2 subsection (a) shall apply to items furnished on or after 

3 the date of enactment of this Act. 

Æ 


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