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 fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives 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 2009’’. 
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SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—The Congress finds the following: 
(1) There are approximately 2,200,000 wheel-
chair users in the United States according to the 
United States Census Bureau of 2001. 
(2) A significant portion of these wheelchair 
users qualify for coverage under the Medicare pro-
gram, either based on disability status or age. 
(3) Many of these Medicare beneficiaries live 
independently in their own homes, alone or with 
other family members. 
(4) The ability of an individual with a mobility 
impairment to move about one’s physical environ-
ment through the use of a wheelchair or other mobil-
ity device permits the performance of activities of 
daily living, including caring for oneself, living inde-
pendently, performing household duties, caring for 
family members, engaging in employment, attending 
school, visiting medical facilities, participating in 
recreational and community activities, attending reli-
gious services, and performing civic duties. 
(5) For an individual with an expected long- 
term mobility impairment (such as a disabling condi-
tion that is expected to significantly limit mobility 
for twelve months or more), the need to have access 
to one’s physical environment through the use of an 
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appropriate wheelchair or other mobility device, both 
inside and outside of the home, is critical to living 
independently, functioning in society, and attaining 
a meaningful quality of life. 
(6) In 1965, when the Medicare program was 
first enacted, Congress recognized the importance of 
providing assistance to individuals with mobility dis-
abilities by expressly identifying wheelchairs as a 
covered durable medical equipment benefit under 
part B of the program when provided for use in the 
patient’s home. This language is widely believed to 
have been drafted to establish a separate payment 
under part B for wheelchairs provided outside of an 
institution (such as a hospital) which would other-
wise be paid under part A of the program. 
(7) The Centers for Medicare & Medicaid Serv-
ices (CMS), the agency that administers the Medi-
care program, currently interprets a provision in the 
Medicare statute—known as the ‘‘in the home re-
quirement’’—to prohibit coverage of wheelchairs and 
other mobility devices if these devices are not medi-
cally necessary for use in the beneficiary’s home, de-
nying access to appropriate mobility devices for a 
significant number of Medicare beneficiaries. 
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(8) The current CMS interpretation of the in 
the home requirement is inconsistent with Federal 
law in the following respects: 
(A) In enacting the Americans with Dis-
abilities Act of 1990 (Public Law 101–336), 
Congress found that ‘‘The Nation’s proper 
goals regarding individuals with disabilities are 
to assure equality of opportunity, full participa-
tion, independent living, and economic self-
sufficiency for such individuals.’’. 
(B) The Rehabilitation Act of 1973 (Public 
Law 93–112) requires that Federal programs 
not discriminate against individuals with dis-
abilities, including individuals with mobility im-
pairments. However, under the current CMS in-
terpretation of the in the home requirement, 
Medicare beneficiaries with long-term mobility 
impairments cannot gain access to mobility de-
vices that facilitate their movement throughout 
the community even when a particular device 
has been determined to be medically necessary 
for this purpose. The result of denying such ac-
cess to appropriate mobility devices is the un-
necessary isolation of the Medicare beneficiary, 
which is inconsistent with the letter and spirit 
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of the Rehabilitation Act of 1973 and its regu-
lations. 
(C) The United States Supreme Court 
ruled in the Olmstead decision (Olmstead v. 
L.C. ex. rel. Zimring, 527 U.S. 581 (1999)) 
that an individual with a disability has the right 
to live in the most integrated setting appro-
priate to meet the individual’s needs. If Medi-
care coverage policy does not take into consider-
ation the needs of individuals with mobility im-
pairments to function outside the four walls of 
their homes, the right to live in the most inte-
grated setting is denied. 
(9) In 1965, and throughout the history of the 
Medicare program, Congress has expected covered 
services to be provided in accordance with current 
standards of medical practice and professional clin-
ical judgment as well as in accordance with Federal 
law. 
(b) PURPOSES.—The purposes of this Act are as fol-
lows: 
(1) To bring CMS’s coverage criteria for wheel-
chairs and other mobility devices in line with con-
temporary standards of medical practice and Federal 
law by correcting CMS’s restrictive interpretation of 
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the in the home requirement language in the Medi-
care statute. 
(2) To ensure that beneficiaries with expected 
long-term mobility needs are not confined to the four 
walls of their homes by wheelchairs and other mobil-
ity devices that are inadequate to meet their needs 
both inside and outside of the home. 
(3) To clarify that wheelchairs and other mobil-
ity devices for beneficiaries with expected long-term 
mobility impairments are covered under the Medi-
care program if they are used in customary settings 
for the purpose of normal domestic, vocational, or 
community activities. 
SEC. 3. 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 Se-
curity Act (42 U.S.C. 1395x(n)) is amended by inserting 
‘‘or, in the case of a mobility device required by an indi-
vidual with expected long-term need, used in customary 
settings for the purpose of normal domestic, vocational, 
or community activities’’ after ‘‘1819(a)(1))’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to items furnished on or after 
the date of enactment of this Act. 
Æ 
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