Imprisoned by Medicare
Senator Dole: Working to Amend Medicare's homebound
requirement
Below please find an excellent Op-Ed article by Bob Dole that appeared in
yesterday's Washington Post. Dole writes eloquently in support of what has
become known as the David Jayne Amendment, which would amend the Medicare
Homebound Restriction to enable people with severe disabilities to participate
in community life without losing access to Medicare home health services.
Advancing Independence: Modernizing Medicare and Medicaid (AIMMM), the Visiting
Nurses Association of America (VNAA), and AAPD are working with the National
Coalition to Amend the Medicare Homebound Restriction (NCAHB), founded by David
Jayne, to change the outdated rule.
The David Jayne Amendment would provide an exception under the homebound rule to
individuals who have permanent and severe disabilities, are unable to leave the
home without personal or technological assistance, and who are eligible for the
Medicare home health benefit. Contact your Senators and Representatives and ask
them to support H.R. 1490 / S. 2085.
Jonathan Young
JFA Editor, AAPD
Imprisoned by Medicare
By Bob Dole
The Washington Post, June 27, 2002
Heroes inspire us to achieve the unachievable, to leave America a better place
for future generations. They remind us that contributing to family and community
is our highest priority. I am fortunate to know such a hero, and his story has
inspired me to help achieve his one simple wish before he dies -- to change a
Medicare restriction so that he and thousands of others who live with permanent
and severe disabilities can leave their homes to see their children grow up and
contribute to their community without losing life-sustaining home health
services.
David Jayne was diagnosed with Lou Gehrig's disease at age 27. Otherwise known
as amyotrophic lateral sclerosis (ALS), this degenerative neuromuscular
condition causes his muscles to atrophy, leaving him unable to eat, breathe or
move on his own. Though his mobility is limited to moving three fingers, Jayne,
now 41, has demonstrated to everyone who knows him or has read about him that
the human spirit is indomitable.
I met David Jayne by chance at Reagan National Airport about a year ago.
Attached to life support equipment and a computerized voice simulator because of
his body's deterioration at the hand of ALS, Jayne had traveled with the help of
friends from his home in Rex, Ga., to meet with his elected members of Congress.
He came to urge them to amend the Medicare homebound restriction.
The homebound rule was intended to deter abuse of the home health benefit by
limiting services to only those individuals whose illnesses and disabilities are
so severe that leaving the home would require "a considerable and taxing
effort." In the 1960s, when this rule was created, it reflected the limits of
health care and technology at the time. It was incomprehensible then to think
that someone with ALS or any severe and permanent disability could leave the
home.
While the homebound restriction has not changed, the role of physicians and home
health providers has. Nurses, doctors and home health administrators have been
turned into watchdogs and given the responsibility to report any knowledge of
their patients leaving their homes. And the awful reality of those receiving
these services is that they must either lie or cheat just to enjoy fundamental
liberties.
This nearly 40-year-old policy reflects an outmoded view of life for persons
with disabilities. Thanks to advances in technology and greater community
accessibility through the passage of the Americans with Disabilities Act (ADA),
people with the most severe disabilities are able to leave their homes to go to
work, volunteer in their communities and enjoy their family and friends.
Unfortunately, Medicare policy has not kept pace with our times and is now
punishing the very people it was intended to benefit. While Medicare has
developed other and better policies to deter abuse, it has kept this outdated
policy.
The Medicare statute does allow for absences from the home of "infrequent" or
"relatively short duration." But the vagueness of this allowance leaves it to
Medicare contractors to interpret just how many absences qualify as "frequent"
and just how short those absences might be. To err on the conservative side,
contractors have stripped home health coverage from those most needing it,
including David Jayne, whose life depends on a ventilator, intravenous feeding
and daily care from a home health aide. Because Jayne's story went public, his
home health agency discontinued these life-sustaining services. They were only
reinstated after members of Congress became involved and Jayne agreed to pay his
home health provider for any claim denied by Medicare. But thousands of others
live in fear of leaving their homes because of the stories that have been
reported. In two heartbreaking cases, one mother's services were cut off after
she attended the funeral for her child, while another mother did not attend the
funeral of her child because of fear of losing her home health care.
For millions of Americans, Medicare-covered home health services provide a less
costly alternative to nursing home or hospital care. There are abuses that
should be corrected, but not by extracting a price that no law-abiding American
should ever have to pay.
David Jayne has inspired many people with his love and determination and his
simple words, "Always wait another day because the next day will be better." He
inspired me to volunteer to try to help.
I urge the House of Representatives to amend this harsh restriction on
individual freedom by including in the Medicare reform bill the David Jayne
Amendment, carefully drafted by Rep. Ed Markey (D-Mass.) and Sen. Susan Collins
(R-Maine), to do what we all know in our hearts is right, including all the
appropriate safeguards to prevent abuse. And if this is not possible because of
cost concerns, to adopt an amendment to provide for those who are severely and
permanently disabled and who require the assistance of an attendant or a skilled
nursing facility.
The amendment should give the Health and Human Services Department six months to
address the homebound rule and make recommendations on how to bring it up to
date with today's technology. Make no mistake, David Jayne is a prisoner -- a
prisoner in his specially designed wheelchair. His illness has robbed him of the
ability to do anything without the aid of technology. Medicare shouldn't act as
jailer too. Thousands of David Jaynes across America are looking to the
president, Congress and the Department of Health and Human Services for help.
-- Former senator Dole is volunteer honorary chairman of the National Coalition
to Amend the Homebound Restriction.
Source:
http://www.washingtonpost.com/wp-dyn/articles/A52363-2002Jun26.html
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