DISABLED CARE: Suit Challenges HCFA Over Home Care Rule
Three quadriplegic women and the National Spinal Cord Injury Association last week filed a class-action suit "challenging a 33-year-old Medicare rule that denies benefits to homebound people if they use today's high-tech wheelchairs to go outside regularly," the Raleigh News & Observer reports. The suit charges that "Medicare's definition of 'homebound' -- written in 1965 before powered wheelchairs with sophisticated controls -- imprisons hundreds and perhaps thousands of people in their homes with its Catch-22 illogic." The News & Observer notes that some disabled people, particularly quadriplegics, "need home health aides to help them leave their apartments. But if they leave, they are no longer considered homebound and don't qualify for aides." One of the plaintiffs, North Carolina native Vicki O'Neal, went through Medicare's appeals process to challenge the rule. But "[e]ven though the appeal eventually had gone in her favor -- an administrative law judge ruled for her last year -- she still was told she couldn't have the benefits." Bill Hatch, an attorney with the North Carolina Governor's Advocacy Council for Persons With Disabilities, "plans to file an injunction in the next two weeks that would force Health Care Financing Administration to pay for O'Neal's home health care until the suit is settled."
HCFA spokesperson Chris Peacock did not comment on the suit, saying only "that home health was intended to be a short-term benefit in such cases." He also said "HCFA and Congress had fine-tuned the regulation in recent years," adding, "We make every effort to make sure that people who are eligible to get the benefit, get it" (Price, 5/8).