Legislators stage battle in Tennesee

Friday, February 29, 2008

CHATTANOOGA, Tenn. - Two Tennessee legislators introduced bills in January that would force the state's Medicaid program to stop using the controversial in-the-home restriction to deny certain power wheelchair claims.
H.B. 2519 and S.B. 2887, introduced by Rep. Mike Turner, D-Old Hickory, and Sen. Joe Haynes, D-Nashville, would revise the definition for DME, deleting "the requirement...that such equipment is appropriate for and used in the patient's home" and not outdoors.
"If we can get something done here, we can get something done in other states," said Darren Jernigan, director of government affairs for Permobil, a Lebanon, Tenn.-based manufacturer of specialized wheelchairs.
About 35 states have followed Medicare's lead in using the in-the-home restriction, Jernigan said, despite a 1999 Supreme Court decision that states people with disabilities must be kept in their least restrictive environments. The Olmstead decision, as it's called, applies only to state and local governments.
Provider Eddie Johnston agrees that the in-the-home restriction "seems so backward."
"It's strange that Medicare encourages providing portable oxygen to get beneficiaries out of the house, but it doesn't encourage providing other equipment to get them out," said Johnston, president of Ed Medical Inc. in Hendersonville, Tenn.
Other providers in Tennessee support Permobil's efforts, but they wonder if they will succeed.
"Without the restriction, how do you qualify who needs certain wheelchairs and who doesn't?" asked one provider. "Wouldn't that open up the floodgates?"
Jernigan has heard that concern before: "We should be approving products based on medical necessity not on where beneficiaries live," he said. "Either you need the chair or you don't."