Lawsuit looks to halt Missouri HME cuts

Sunday, September 4, 2005

JEFFERSON CITY, Mo. -- Several disabled Missourians have filed a lawsuit to stop the state from implementing a series of cuts to the state's Medicaid program that would reduce durable medical equipment expenditures from about $58 million to $33 million in the next fiscal year.

While Missouri will continue to pay for oxygen, wheelchairs and diabetic supplies, the state has not budgeted funding for such equipment as hospital beds, wheelchair batteries, feeding tubes and other DME.

The state has said it would grant exceptions to beneficiaries who need equipment to sustain life, to substantially improve quality of life or to prevent a higher level of care.

But the lawyer who filed the lawsuit said the state's promise to care for people in the most dire straits is a crock.

"One of our clients, who is named plaintiff in the case, has attempted to obtain an exception and he has not got one," said attorney Thomas E. Kennedy of Alton, Ill. "He will die if he doesn't get one."

Suppliers are hoping the exception clause will preserve some business now in jeopardy.

"It's some improvement over what we were facing, which was a complete cutoff in reimbursement for certain items," said Brady Vestal, director of Citizens Memorial Home Care in Bolivar, Mo., and chairman of the state's HME association.

Nevertheless, trying to provide equipment like CPAP to Medicaid recipients is likely to be much more of an uphill battle.

"If a patient has OSA, they are never going to get rid it, most likely. Is that life-threatening?" said Vestal. "My concern is how does the Medicaid program define terminally ill."

Vestal believes the state legislature singled out DME for cuts because the services are deemed an "optional" service. Durable medical equipment scams like the Wheeler Dealer scandal have also left the industry peculiarly vulnerable to cost-cutters.

The Midwest Association of Medical Equipment Suppliers has not joined any of the lawsuits seeking injunctions.

"In my opinion, that's a confrontational approach," said Vestal. "We've been able to achieve success with a cooperative approach."