WASHINGTON--Sen. Thomas Harkin, D-Iowa, called for the "in the home" policy currently governing Medicare's reimbursement of wheelchairs to be changed because it does not reflect users' needs and hampers fulfillment of the goals of the Americans with Disabilities Act, the American Association for Homecare reported.

Speaking at a Washington briefing on disability policy issues last week, Harkin, who chairs the Labor, Health and Human Services and Education Subcommittee of the Senate Appropriations Committee, said the ADA needs to be restored because the law has been interpreted more narrowly than Congress originally intended.

"We need to review and reform Medicare policies from a disability perspective," Harkin said. "For example, how can we expect the ADA's goals to be fulfilled when the largest purchaser of health care in this country, Medicare, pays only for wheelchairs that are appropriate for use in a person's home--giving no consideration to the need for mobility in the community and in the workplace? This so-called 'in the home' policy has got to be changed."

Sharon Hildebrandt, executive director of the National Coalition for Assistive and Rehab Technology, applauded Harkin's comment.

"It's encouraging to hear Sen. Harkin say this," Hildebrandt said. "It is a critical issue for people with disabilities who need wheeled mobility. In order to be fully functioning and meet their potential, people with disabilities need to have access to their communities. NCART is fully supportive of revising this onerous interpretation of the Medicare law that restricts access."

Cara Bachenheimer, vice president of government relations for Elyria, Ohio-based Invacare, also thought Harkin's comments were encouraging. "CMS has an overly restrictive interpretation of the law which effectively confines consumers to their homes, and limits the ability of beneficiaries to obtain the most medically appropriate device that enables the beneficiary to be an active member of his or her community, " she said.

Bachenheimer noted that two bills were introduced last year in the House and Senate that would have repealed the section of the law that CMS is interpreting as limiting coverage of mobility devices to "in the home."

In 2005, 34 senators and 70 representatives signed a letter to HHS asking that the restriction be modified through the regulatory process (see HomeCare, August 2006). The government responded that legislation would be required to make the appropriate changes, prompting introduction of the bills, but the 109th Congress adjourned without taking action.

Harkin was the chief sponsor of the ADA when it debuted in 1990. His advocacy for the rights of the disabled goes back to his childhood, when his 7-year-old brother Frank became deaf after contracting spinal meningitis and then faced many barriers, both physical and cultural. That bothered Harkin, who has since won a reputation as a champion of rights for those with disabilities.