skip navigation links
 

Advocacy Alerts

Proposed State Regulations:

Proposed Federal Legislation:

Proposed State Legislation:

Action Resources:

114.3 CMR 22.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment

NOTICE OF PUBLIC HEARING

Pursuant to the provisions of M.G.L. c.118G and in accordance with M.G.L. c. 30A, as amended, a public hearing will be held Wednesday, December 16, 2009 at 10:00 AM at the Division of Health Care Finance and Policy (“Division”), 2 Boylston Street, 5th floor, Boston, MA relative to the adoption of amendments to: 

            114.3 CMR 22.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment

The amendments revise the payments for durable medical equipment, oxygen and respiratory therapy equipment services to publicly aided patients effective January 1, 2010. Rates for most services are updated from a percentage of  the 2006 Medicare fees to 80% of 2009 Medicare fees, with the following exceptions:  (1) the rate for blood glucose test strips remains at $36.94; (2) the rate for code E0784 (external ambulatory insulin infusion pump), decreases from $6,489.30 to $4,603.73, the 2009 Medicare fee; (3) the rates for three oral enteral formulas(E4150BO, E4152BO, and E4153BO), increase between 3.85% to 5.11%, the difference between the 2003 Medicare rates used to calculate current rates and the 2009 Medicare rates; (4) the rate methodology for incontinence products is changed, with new rates based on the median of maximum prices for a sample of products from the HSP 28 Medical Commodities Contract for public purchasers, plus a 20% markup for billing and administrative costs. Rates for most incontinence products decrease using the new methodology; (5) the rate for assistive technology professional, formerly known as rehabilitation technology specialist increases from $15.93 to $22.40 per 15 minutes, based on 100% of 2009 Medicare fees; the rates for other repair, labor codes and non-routine servicing, including oxygen, increase from $9.64 to $17.92 based on 80% of 2009 Medicare fees; the rates for specialized mobility systems, volume ventilator rentals, months one through six, whose codes use the U2 modifier and speech generation device codes E2504, E2506, E2508, and E2510 are set at 100% of the 2009 Medicare fee where Medicare fees exist; (6) for items for which there is a current fee and no Medicare fee, the rate is unchanged. The amendments also replace labor codes for repair and non-routine servicing of durable medical equipment (K0739) and oxygen (K0740); add definitions for Prescribing Provider and RESNA; and amend the definitions of Capped, Rental, Respiratory Therapy Services and Supplies, Customized Equipment, Home Infusion Therapy Services, Medical Supplies, Seating Clinic, Standard Markup, Wheeled Mobility System and Usual and Customary Charge. Approximately 38% of the rates are reduced, 38% are increased and the rest stay the same. In addition, the amendments clarify provider responsibility in the event of a product recall and clarify that any costs not covered by the manufacturer or any other third party for activity associated with such recalls are included in the general rate. The amendments also incorporate coding updates and changes made by information bulletins. 

The Division is proposing these amendments to maintain access to services and to ensure that the rates are consistent with efficiency, economy, and quality of care.  It is estimated that aggregate annual MassHealth expenditures will decrease by $2.84 million, or 7.47%, as a result of these amendments.  The fiscal impact upon cities and towns will depend on the volume and mix of services purchased and is expected to be minimal.    

Interested parties are encouraged to submit comments on these amendments.  All persons desiring to be heard on this matter are hereby notified to appear at the designated time and place.  Persons intending to speak will be afforded an early opportunity to testify if the Division receives notice by 5:00 pm on Tuesday, December 15, 2009.  All others will be heard subsequently. Written comments may be sent to the Division at Two Boylston Street, 5th floor, Boston, MA 02116. Copies of the regulation are available for inspection and/or purchase at the Division, Two Boylston Street, 5th floor, Boston, MA 02116 or you can access them free of charge in the Regulations section of the Division’s web site located at www.mass.gov/dhcfp.

If you wish to testify at an upcoming Public Hearing please contact:
Corine Peach, Legal
617-988-3126
Corine.Peach@State.MA.US

House Bill 3184: The Medicare Independent Living Act of 2009

Introduced by Rep. James R. Langevin (RI-2) on July 13, 2009. The bill would remove the in-home restriction on coverage of mobility devices by Medicare for individuals with expected long-term needs. It would allow mobility device provided by Medicare to be used for community and vocational needs.

Bill Text:

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

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 Representatives 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'.

SEC. 2. FINDINGS AND PURPOSES.

(a) Findings- The Congress finds the following:

(1) There are approximately 2,200,000 wheelchair 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 program, 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 environment through the use of a wheelchair or other mobility device permits the performance of activities of daily living, including caring for oneself, living independently, performing household duties, caring for family members, engaging in employment, attending school, visiting medical facilities, participating in recreational and community activities, attending religious services, and performing civic duties.

(5) For an individual with an expected long-term mobility impairment (such as a disabling condition 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 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 disabilities 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 otherwise be paid under part A of the program.

(7) The Centers for Medicare & Medicaid Services (CMS), the agency that administers the Medicare program, currently interprets a provision in the Medicare statute--known as the `in the home requirement'--to prohibit coverage of wheelchairs and other mobility devices if these devices are not medically necessary for use in the beneficiary's home, denying access to appropriate mobility devices for a significant number of Medicare beneficiaries.

(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 Disabilities 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 participation, independent living, and economic selfsufficiency for such individuals.'.

(B) The Rehabilitation Act of 1973 (Public Law 93-112) requires that Federal programs not discriminate against individuals with disabilities, including individuals with mobility impairments. However, under the current CMS interpretation of the in the home requirement, Medicare beneficiaries with long-term mobility impairments cannot gain access to mobility devices 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 access to appropriate mobility devices is the unnecessary isolation of the Medicare beneficiary, which is inconsistent with the letter and spirit of the Rehabilitation Act of 1973 and its regulations.

(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 appropriate to meet the individual's needs. If Medicare coverage policy does not take into consideration the needs of individuals with mobility impairments to function outside the four walls of their homes, the right to live in the most integrated 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 clinical judgment as well as in accordance with Federal law.

(b) Purposes- The purposes of this Act are as follows:

(1) To bring CMS's coverage criteria for wheelchairs and other mobility devices in line with contemporary standards of medical practice and Federal law by correcting CMS's restrictive interpretation of the in the home requirement language in the Medicare 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 mobility devices that are inadequate to meet their needs both inside and outside of the home.

(3) To clarify that wheelchairs and other mobility devices for beneficiaries with expected long-term mobility impairments are covered under the Medicare 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 Security Act (42 U.S.C. 1395x(n)) is amended by inserting `or, in the case of a mobility device required by an individual with expected long-term need, used in customary settings for the purpose of normal domestic, vocational, or community activities' after `1819(a)(1))'.

(b) Effective Date- The amendment made by subsection (a) shall apply to items furnished on or after the date of enactment of this Act.


Back to top

House Bill 3101: The Twenty-first Century Communications and Video Accessibility Act of 2009

H.R. 3101, the 21st Century Communications and Video Accessibility Act was introduced June 26, 2009, in the U.S. House of Representatives by Ed Markey (D-MA).  If enacted, this disabilities communications legislation will amend the nation’s Communications Act to ensure that new Internet-enabled telephone and television products and services are accessible to and usable by people with disabilities. It will also close existing disability gaps in telecommunications law.

Below is a summary of the bill as provided by the Coalition of Organizations for Accessible Technology (COAT). Included are comparisons to laws that already exist Where there is no reference to an existing law, there is no current law on the subject. Click here for action steps and to read the bill's text at the COAT Web site. 

COMMUNICATIONS ACCESS

  • Requires access to phone-type equipment and services used over the Internet. Current law:  Section 255 of the Communications Act only requires access to telecommunications product and services.
  • Adds improved accountability and enforcement measures for accessibility, including a clearinghouse, outreach, and reporting obligations by providers and manufacturers.     
  • Requires phone-type products used with the Internet to be hearing aid compatible (HAC). Current law: HAC is required on all wireline and many wireless phones.
  • Allows use of Lifeline and Link-up universal service funds (USF) for broadband services. Current law:  Discounts are only available for products, and services on public telephone network.
  • Allocates up to $10 million each year for equipment used by people who are deaf-blind. (Currently: Inadequate state programs that distribute some free or discounted telephone equipment, but little available for people who are deaf-blind)
  • Clarifies the scope of relay services to include calls between and among people with disabilities and requires Internet-based service providers to contribute to the Interstate Relay Fund.
  • Requires FCC to develop real-time text digital standard to replace TTY communications
 
VIDEO PROGRAMMING ACCESS

  • Requires caption decoder circuitry or display capability in all video programming devices, including PDAs, computers, iPods, cell phones, DVD players, TiVo devices and battery-operated TVs (Current law: Caption decoder circuitry only required on TVs with screens at least 13 inches)

  • Extends closed captioning obligations to video programming provided by, or generally considered comparable to programming provided by, a television broadcast station, even when distributed over the Internet: covers video programming that was previously captioned for television viewing, live video programming, and new video programming provided by or generally considered to be comparable to programming provided by multichannel programming distributors; does not cover user-generated content (e.g., YouTube videos posted by individuals) (Current law: Captioning required on most broadcast, cable and satellite TV shows)

  • Requires easy access to closed captions via remote control and on-screen menus

  • Requires easy access by blind people to television controls and on-screen menus

  • Restores video description rules and requires access to televised emergency programming for people who are blind or have low vision

Back to top

The following assistive technology related bills are up for consideration by the Massachusetts General Court (the state legislature):

Senate Bill No. 961

An Act to Promote Safety in Multi-Story Buildings

S961 is sponsored by Senator Joan Menard. The bill would improve the safety of those with disabilities living in high-rise buildings by requiring that certain buildings have evacuation chairs. There is a hearing scheduled with the Joint Committee on Public Safety on June 25, 2009, 11:00 a.m. in room B-2 of the State House. You are welcome to testify on your own experiences, especially if you live in a high-rise building.

Bill text:

An Act to Promote Safety in Multi-story Building

CHAPTER 148. FIRE PREVENTION shall be amended by adding Section 26J as follows:

Evacuation chairs required in certain residential and commercial structures; regulation; inspections; enforcement

Section 26J. (a) Every dwelling, building or structure, including those owned or operated by the commonwealth, occupied in whole or in part for residential, commercial or non-commercial purposes, that: (1) is over four stories in height or (2) has occupied space above the height of the tallest fire department ladder shall be equipped with approved evacuation chairs on each stair well or evacuation route.

(b) The board of fire prevention regulations shall promulgate such regulations as may be necessary to effectuate this section including, but not limited to, the type, installation, location, maintenance and inspectional requirements of evacuation chairs or evacuation equipment as the board determines appropriate.   (More….)

(e) The head of the fire department or his/her designee shall enforce this section.

Senate Bill No. 445

AN ACT RELATIVE TO PRESCRIPTION DRUG VOICE SYNTHESIZERS

S445 is sponsored by Sen. Baddour.

The bill requires health insurance providers to cover the expense of a medically prescribed voice-synthesizer (better known as Talking RX, see www.talkingrx.com) so that information for a prescription can be recorded and supplied with a prescription bottle for those who are legally blind or visually impaired.

Bill text:

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Chapter 175 of the General Laws is hereby amended by inserting after section 47W the following section:-

Section 47X. For the purposes of this section, the following word shall have the following meaning, unless the context clearly otherwise requires: “voice synthesizer”, a product that attaches to bottles and or reads electronically a code on the label of a prescription which verbally then converts the textual information encoded by a screen-reader and feeds it to the soundcard for oral reproduction. Any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 which provides prescription drug insurance, which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policyholder within or without the commonwealth shall provide coverage for the expense of a medially prescribed voice-synthesizer used in connection with a container that would provide audible information of a prescription for use by a person who is legally blind or visually impaired. The policy holder shall be responsible for returning the container to a pharmacist for refill.

SECTION 2. The Commissioner of the Division of Insurance shall adopt regulations to implement and provide information of Chapter 147 Section 47X of the General Laws within 90 days of its effective date.

SECTION 3. Notwithstanding any general or special law to the contrary, an individual, public or private institution, business or other organization that regularly and primarily provides a service to a disabled person shall inform the disabled person of the availability of the voice synthesizer referred to in section 47X of chapter 175 of the General Laws.

Back to top