S-2831-119
Read twice and referred to the Committee on Finance.
Sponsored by Angus King (I-ME)
What it does
This bill would amend Title XVIII of the Social Security Act to add certain fall prevention items — including grab bars, non-slip mats, shower chairs, and bed rails — to Medicare's durable medical equipment (DME) coverage. Coverage would require a physician or practitioner order. The bill would also exempt payments for these items from sequestration cuts under the Balanced Budget and Emergency Deficit Control Act and other deficit-reduction laws, taking effect 60 days after enactment.
Who benefits
Medicare beneficiaries (approximately 67 million enrollees), particularly older adults and people with disabilities who are at elevated fall risk. Physicians and practitioners who would gain a new prescribing pathway. Manufacturers and retailers of grab bars, non-slip mats, shower chairs, and bed rails, who would gain a large new federally reimbursed customer base. Home health agencies and DME suppliers who would handle fulfillment. Caregivers and family members of Medicare beneficiaries who may currently pay out-of-pocket for these items.
Who is hurt
Medicare trust funds and federal taxpayers, who would bear the cost of the new benefit and the sequestration exemption. Competing DME categories that remain subject to sequestration cuts, which may face relative disadvantage in reimbursement. Potentially, Medicare beneficiaries broadly, if the added spending accelerates cost pressures on premiums or cost-sharing. Fiscal watchdog organizations and lawmakers prioritizing deficit reduction, who would lose sequestration savings on this spending category.
Supporters argue
Supporters argue that falls are the leading cause of injury-related death among adults 65 and older, with the CDC estimating 36 million falls annually among older adults resulting in roughly $50 billion in medical costs. They contend that covering low-cost preventive equipment like grab bars and non-slip mats would reduce far more expensive downstream Medicare spending on hospitalizations, surgeries, and rehabilitation — making the benefit fiscally prudent as well as medically sound.
Opponents argue
Opponents argue that expanding Medicare to cover household fixtures like grab bars and non-slip mats blurs the line between medical equipment and home improvement, potentially opening the door to broader and harder-to-administer coverage expansions. They contend that the sequestration exemption sets a problematic precedent by carving out a specific benefit from deficit-control mechanisms, and that without rigorous cost-effectiveness data on this specific coverage, the net fiscal impact on Medicare's already-strained trust funds is uncertain.
Constitutional context
Congress has broad authority to structure Medicare benefits under the Taxing and Spending Clause (Art. I, §8, cl. 1), and NFIB v. Sebelius (2012) affirmed Congress's wide latitude to define the scope of federal spending programs. No significant constitutional challenge is apparent for this type of incremental benefit expansion to an existing program.
Checks and balances
Congress expands the benefit and exempts it from sequestration; the Secretary of HHS gains authority to specify additional covered item categories beyond those listed; CMS implements reimbursement rules subject to standard notice-and-comment rulemaking, and post-Loper Bright, courts would independently review any agency interpretations of the new statutory language.
Historical precedent
Medicare has previously expanded DME coverage to include items such as continuous positive airway pressure (CPAP) devices and power wheelchairs through similar statutory amendments to Section 1861 of the Social Security Act.