Using a posting in the Federal Register as a springboard, a new coalition is pushing for revision of a section of the Social Security Act, which it believes is being misinterpreted by the durable medical equipment regional carriers and thus is resulting in beneficiaries being denied needed equipment.

The nine-member Coalition to Promote Independence for People with Disabilities is questioning Section 1861 (n) of the act, which requires that durable medical equipment be used in the patient's home, rather than a hospital or skilled nursing facility, for Medicare Part B reimbursement. While Congress excluded from Part B coverage of DME provided in those institutional settings, it didn't impose a geographical qualification requirement for DME, such as by covering only items needed for daily activities performed in the home.

According to the coalition, which includes Sunrise Medical, The Med Group, VGM, the American Association for Homecare and other organizations, there is no statutory limitation on Medicare coverage of medically necessary DME that would enable a beneficiary to leave the home to go to work, attend school or attend religious services, among other activities.

For example, the DMERCs will cover a standard wheelchair for a disabled person for use within the four walls of the person's home. However, if that same beneficiary requires a different level of wheelchair — such as a high-strength or ultra-lightweight model — to be independent in community living, that product would be denied as not medically necessary, the coalition says.

“In effect, a policy that was designed only to distinguish between institutional and non-institutional settings is now a significant barrier preventing individuals with disabilities from participating fully in the social and economic life of the community,” the coalition said in a written statement.

“Coalition members believe that this interpretation goes way beyond Congressional intent and is an absolute contradiction with the Americans with Disabilities Act, The Ticket to Work Act, as well as the [Bush] Administration's recent ‘New Freedom Initiative.’”

“We believe that this is an enormously important initiative,” said Rita Hostak, vice president of government relations for Carlsbad, Calif.-based Sunrise Medical, the key driving force behind the initiative. “A small amendment in an interpretation would have a tremendous impact on the lives of people with disabilities, freeing them up to actively participate in all life has to offer.”

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