{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T08:44:44Z","timestamp":1750754684917},"reference-count":57,"publisher":"Springer Publishing Company","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Care Management Journals"],"published-print":{"date-parts":[[2005,3]]},"DOI":"10.1891\/cmaj.2005.6.1.29","type":"journal-article","created":{"date-parts":[[2005,12,5]],"date-time":"2005-12-05T19:12:36Z","timestamp":1133809956000},"page":"29-37","source":"Crossref","is-referenced-by-count":4,"title":["Forcing Isolation: Medicare\u2019s \u201cIn the Home\u201d Coverage Standard for Wheelchairs"],"prefix":"10.1891","volume":"6","author":[{"family":"Medicare Rights Center","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"793","published-online":{"date-parts":[[2005,3,1]]},"reference":[{"key":"ref1_1","unstructured":"Durable medical equipment is medical equipment that a doctor orders for use in the home. These items must be reusable, such as walkers, wheelchairs or hospital beds."},{"key":"ref2_2","unstructured":"The Centers for Medicare and Medicaid Services is the federal agency that oversees and administers the Medicare program."},{"key":"ref3_3","unstructured":"Chevron, U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 863 (1984)."},{"key":"ref4_4","unstructured":"See MCM \ufffd 2100.2."},{"key":"ref5_5","unstructured":"SSA \ufffd 1862(a)(I)(A); 42 USC \ufffd 1395y(a)(I)(A). (?No payment may be made under part A or part B for any expenses incurred for items and services?which ? are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.?)"},{"key":"ref6_6","unstructured":"Id.; Certificate of Medical Necessity: Motorized Wheelchairs, CMS-843, 05\/97. Certificates of Medical Necessity are standard CMS forms that doctors and suppliers must complete before Medicare will pay claims for certain Durable Medical Equipment items, including wheelchairs."},{"key":"ref7_7","unstructured":"Certificate of Medical Necessity: Power Operated Vehicle, CMS-850, 4\/96."},{"key":"ref8_8","unstructured":"?Power Wheelchairs and POVs?Policy Clarification and Medical Review Strategy,? December 9, 2003. Issued by the Durable Medical Equipment Regional Carriers."},{"key":"ref9_9","unstructured":"CMS National Coverage Decisions for Durable Medical Equipment Reference List (60-9)."},{"key":"ref10_10","unstructured":"CMS forms for manual wheelchairs ask whether patients ?require and use the wheelchair to move about the residence.? Certificate of Medical Necessity: Manual Wheelchairs, CMS-844."},{"key":"ref11_11","unstructured":"Kaye, H. S., Kang, T., Laplante, M. R., Disability Statistics Report?Mobility Device Use in the United States, June 2000. Washington, D.C.: U.S. Dept. of Education, National Institute of Disability and Rehabilitation Research."},{"key":"ref12_12","unstructured":"Seewww.spinlife.com. The figures are derived from manufacturer's list prices and include the price of accessories."},{"key":"ref13_13","unstructured":"Seewww.spinlife.com."},{"key":"ref14_14","unstructured":"Id."},{"key":"ref15_15","unstructured":"See CMS press release, ?New Efforts Aimed at Stopping Abuse of the Power Wheelchair Benefit in the Medicare Program,? Sept. 9, 2003,www.cms.hhs.gov\/media\/press\/release.asp?Counter=843."},{"key":"ref16_16","unstructured":"Social Security Act Sec.\ufffd 1862(a)(I)(A); 42 USC \ufffd1395y(a)(I)(A)."},{"key":"ref17_17","unstructured":"Medicare Home Health Manual \ufffd 205.2."},{"issue":"3","key":"ref18_18","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1093\/geront\/43.3.335","volume":"43","author":"Agree","year":"2003","journal-title":"The Gerontologist"},{"key":"ref19_19","unstructured":"Estimated according to the following pay rate: $15.50\/hour, 20 hours\/week ($310), 52 weeks\/year ($16,120) less 25 percent for taxes ($4,030) = $12,090 annual part-time salary. This is calculated without taking into account employee benefits or fringe. Full-time salary estimated using the same numbers at 40 hours\/week."},{"key":"ref20_20","unstructured":"?Estimating the Cost of Wheelchairs Under a Limited Modification of the ?In the Home? Standard for Medicare Durable Medical Equipment,?Sunrise Medical, February 25, 2002."},{"key":"ref21_21","unstructured":"MCM \ufffd 2100.2. A specialist in physical medicine, orthopedic surgery, neurology, or rheumatology must prescribe power-operated devices. Coverage Issues Manual \ufffd 60-5."},{"key":"ref22_22","unstructured":"Section 302(a)(2) of the ?Medicare Prescription Drug, Improvement, and Modernization Act of 2003.?"},{"key":"ref23_23","unstructured":"Iezzoni, L.When Walking Fails: Mobility Problems of Adults with Chronic Conditions, University of California Press: 2003."},{"key":"ref24_24","unstructured":"Sitting for long periods without relieving pressure causes the muscle and fat tissues to break down, putting the skin in closer contact with the bone. Closer contact with the bone causes more pressure on the skin. Further, the lack of air circulation between your body and the cushion causes heat and moisture to build up against your skin, causing skin breakdown. Karp, G.Choosing a Wheelchair, a Guide for Optimal Independence"},{"key":"ref25_25","unstructured":"Id."},{"key":"ref26_26","unstructured":"At the current time, about 1,200 therapists nationwide have credentialing from the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).www.resna.org."},{"issue":"9","key":"ref27_27","doi-asserted-by":"crossref","DOI":"10.1046\/j.1532-5415.2003.51408.x","volume":"51","author":"Hoenig","year":"2003","journal-title":"Journal of the American Geriatrics Society"},{"issue":"4","key":"ref28_28","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/geront\/37.4.433","volume":"37","author":"Rowe","year":"1997","journal-title":"Gerontologist"},{"key":"ref29_29","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(95)00117-P"},{"issue":"9","key":"ref30_30","doi-asserted-by":"crossref","DOI":"10.1046\/j.1532-5415.2003.51408.x","volume":"51","author":"Hoenig","year":"2003","journal-title":"Journal of the American Geriatrics Society"},{"issue":"5","key":"ref31_31","volume":"38","author":"Rodgers","year":"2001","journal-title":"Journal of Rehabilitation Research and Development"},{"key":"ref32_32","unstructured":"42 USC \ufffd 1395x(n) (?The term ?durable medical equipment? includes iron lungs, oxygen tents, hospital beds, and wheelchairs (which may include a power-operated vehicle that may be appropriately used as a wheelchair, but only where the use of such a vehicle is determined to be necessary on the basis of the individual's medical and physical condition and the vehicle meets such safety requirements as the Secretary may prescribe) used in the patient's home (including an institution used as his home other than an institution that meets the requirements of subsection (e)(1) of this section or section 1395i-3(a)(1) of this title).?)"},{"key":"ref33_33","unstructured":"Generally, federal administrative agencies like CMS are allowed broad discretion by the courts in interpreting ambiguous provisions in an enabling statute, so long as any one interpretation is reasonable and consistent with the purposes of the broader act. SeeChevron U.S A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 842?43 (1984). Courts routinely allow agencies the discretion to modify and even reverse interpretations of statutes so long as the newer interpretation does not violate the plain meaning or overall purpose of the Act. SeeRobertson v. Methow Valley Citizens Council, 490 U.S. 332, 355?56 (1989);United States v. Alaska, 503 U.S. 569, 582?83 (1992). A court will overrule an agency interpretation of a statue when it is arbitrary, capricious or evidently in conflict with the statute. SeeChevron, 467 U.S. at 843."},{"key":"ref34_34","unstructured":"See, e.g.Pierce v. Underwood, 487 U.S. 552 (1988);Local Division 589 v. Massachusetts, 666 F.2d 6118 (1st Cir. 1981)."},{"key":"ref35_35","unstructured":"See, e.g., L. 89-97, Social Security Amendments of 1965, House Report (Ways and Means Committee) No. 89-213, No. 89-682, Senate Report No. 89-404."},{"key":"ref36_36","unstructured":"SeeKing v. St. Vincent Hospital, 502 U.S. 215, 221 (1991)."},{"key":"ref37_37","doi-asserted-by":"crossref","unstructured":"Karp 1998; 3?10.","DOI":"10.1097\/00001622-199801000-00002"},{"key":"ref38_38","unstructured":"United States v. Estate of Romani, 523 U.S. 517, 530?531 (1998);United States v. Fausto, 484 U.S. 439, 453 (1988)."},{"key":"ref39_39","unstructured":"28 C.F.R. \ufffd 41.51."},{"key":"ref40_40","unstructured":"For example, inGalusha v. New York State Department of Environmental Conservation, the court struck down the state parks agency's decision to limit motorized access for visitors with disabilities to certain areas within parklands, finding that Section 504 aims to ?assure evenhanded treatment between the disabled and ablebodied.? 27 F.Supp.2d 117, 124 (N.D.N.Y. 1998). Similarly, inTugg v. Towey, the court rejected the state's refusal to provide mental health providers with sign language skills to deaf members of the community. 864 F.Supp. 1201, 1209?10 (S.D. Fla. 1994)."},{"key":"ref41_41","unstructured":"See Laurence Paradis, ?Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act: Making Programs, Services, and Activities Accessible to All,?Stanford Law and Policy Review(2003)."},{"key":"ref42_42","unstructured":"42 USC \ufffd 12101(b)(1)."},{"key":"ref43_43","unstructured":"Wodatch, J. ?The ADA: What It Says,?Worklife, 27?48 (1993)."},{"key":"ref44_44","unstructured":"SeeOlmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (1999);Townsend v. Quasim, 328 F.3d 511, 517 (9th Cir. 2003)."},{"key":"ref45_45","unstructured":"527 U.S. 581, 600 (1999)."},{"key":"ref46_46","unstructured":"Id. at 600."},{"key":"ref47_47","unstructured":"Id. at 601."},{"key":"ref48_48","unstructured":"Id. at 607. Individuals must be treated in a community setting when (1) the state's professionals have determined that an individual ?meets the essential eligibility? requirements for habilitation in a community-based setting (i.e., treatment in the community is ?appropriate?); (2) the affected individual does not oppose transfer or placement in a community-based setting; (3) the placement can be reasonably accommodated, taking into account the resources of the state and the needs of others with mental disabilities.Olmstead, 527 U.S. at 607."},{"key":"ref49_49","unstructured":"Frederick L. v. Dept. of Pub. Welfare, 157 F.Supp.2d 509, 534?35(cite) (holding that legislative history of \ufffd 504 and enactment of 28 C.F.R. \ufffd 41.51 prove that Rehabilitation Act contains an integration mandate).See also Makin ex rel. Russell v. Hawaii, 114 F.Supp.2d 1017, 1035?46 (D. Haw.1999) (ADA and Rehab Act);PA Prot. & Advocacy, Inc. v. Dep't of Pub. Welfare, 243 F.Supp.2d 184, 190 (2003) (Rehab. Act and ADA produce an integration mandate);Martin v. Taft, 22 F. Supp.2d 940, 967 (2002) (ADA and Rehab. Act)."},{"key":"ref50_50","unstructured":"P.L. 106-171, 42 USC \ufffd 1395i."},{"key":"ref51_51","unstructured":"See TWWIIA, Section 2(b)(3); 42 USC \ufffd 1395i-2a."},{"key":"ref52_52","unstructured":"Executive Order 13217, ?Community-Based Alternatives for Individuals with Disabilities,? June 18, 2001."},{"key":"ref53_53","unstructured":"Assistive technology is any item, piece of equipment, or system, whether acquired commercially, modified, or customized, that is commonly used to increase, maintain, or improve functional capabilities of individuals with disabilities (Public Law 100-407)."},{"key":"ref54_54","unstructured":"SeeNew York v. FERC, 122 S. Ct. 1012, 1017 (2002);Chevron, U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 863?64 (1984);National Labor Relations Board v. J. Weingarten, Inc., 420 U.S. 251, 265 (1975). This development is not usual for long-standing statutes: When circumstances change, statutory interpretation becomes especially difficult. Older statutes may depend on factual assumptions that no longer hold, or may conflict with more recent statutes, thus producing inconsistency and incoherence in regulation. This problem is complicated by the fact that the statutory term may have been clear when enacted, and at the time it may have been inappropriate to invoke controversial substantive norms to interpret it; but changed conditions can render a term ambiguous and thus make it appropriate to apply conspicuous or controversial norms. Cass R. Sunstein,Interpreting Statutes in the Regulatory State, 103 Harv. L. Rev. 405, 493 (1989)."},{"key":"ref55_55","unstructured":"Chevron, U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 863 (1984)."},{"key":"ref56_56","unstructured":"Id. at 866. For example, the Forest Service originally interpreted the National Environmental Policy Act to require a ?worst-case analysis? in certain permit applications.Robertson v. Methow Valley Citizens Council, 490 U.S. 332, 354 (1989). The Forest Service later changed its rules to require an analysis that was, in some respects, less demanding.Id. at 355. Despite the change, the regulation received substantial deference, on the grounds that ?the amendment only came after the prior regulation had been subjected to considerable criticism? and ?was designed to better serve the twin functions of an [Environmental Impact Statement]?requiring agencies to take a ?hard look? and the consequences of the proposed action and providing important information to other groups and individuals.?Id. at 356. New social mores have prompted agencies to reinterpret ambiguous statutes. InRust v. Sullivan, the Court evaluated regulations promulgated by the Secretary of Health and Human Services 18 years after enactment of the statute. 500 U.S. 173, 177?179 (1991). These regulations departed from the Secretary's past policy, but the Court upheld them nonetheless. According to the Court, the Secretary provided a ?reasoned analysis? to support the change: The Secretary explained that the regulations are a result of his determination, in the wake of the critical reports of the General Accounting Office (GAO) and the Office of the Inspector General (OIG), that prior policy failed to implement properly the statute and that it was necessary to provide ? ?clear and operational guidance? to grantees about how to preserve the distinction between Title X programs and abortion as a method of family planning.? 53 Fed. Reg. 2923?2924 (1988). He also determined that the new regulations are more in keeping with the original intent of the statute, are justified by client experience under the prior policy, and are supported by a shift in attitude against the ?elimination of unborn children by abortion.? We believe that these justifications are sufficient to support the Secretary's revised approach.Id. at 187. As Rust suggests, the Court remains committed toChevron'smandate that statutes should not be interpreted in a ?sterile textual vacuum,? but rather ?in light of everyday realities.? 467 U.S. at 863, 866. See alsoMotor Vehicle Mfrs. Ass'n v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29 (1983) (asserting that ?an agency must be given ample latitude to ?adapt their rules and policies to the demands of changing circumstances??)."},{"key":"ref57_57","unstructured":"Skubel v. Fuoroli, 113 F.3d 330, 64 (2nd Cir. 1997) (holding as unreasonable a regulation that limited home health services covered by Medicaid to those services provided to a recipient at his or her ?place of residence?);Detsel by Detsel v. Sullivan, 895 F.2d 58 (2nd Cir. 1990) (holding that regulation restricting private duty nursing under Medicaid to services provided in home, hospital or skilled nursing facility was unreasonable because based on a ?static and obsolete view of the relevant facts?).See also Freeman v. National Broadcasting Company, Inc.(2nd Cir. 1996)."}],"container-title":["Care Management Journals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1891\/cmaj.2005.6.1.29","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,11]],"date-time":"2020-04-11T10:43:54Z","timestamp":1586601834000},"score":1,"resource":{"primary":{"URL":"http:\/\/connect.springerpub.com\/lookup\/doi\/10.1891\/cmaj.2005.6.1.29"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,3]]},"references-count":57,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2005,3,1]]},"published-print":{"date-parts":[[2005,3]]}},"alternative-id":["10.1891\/cmaj.2005.6.1.29"],"URL":"https:\/\/doi.org\/10.1891\/cmaj.2005.6.1.29","relation":{},"ISSN":["1521-0987","1938-9019"],"issn-type":[{"value":"1521-0987","type":"print"},{"value":"1938-9019","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,3]]}}}