Medicaid also uses restriction

Wednesday, May 31, 2006

YARMOUTH, Maine - While the industry has focused most of its lobbying muscle on lifting the in-the-home restriction on a federal level, various Medicaid programs have adopted the restriction, too, leading to access problems, industry sources report.
In Florida, especially, providers like Tom McEnany tell stories of a Medicaid program that, despite requirements that children with disabilities attend school, won't pay for the wheelchair tie downs or the headrests needed to get them there safely.
"Florida implements the in-the-home restriction extensively," said McEnany, owner of Wheelchairs Plus in Jacksonville. "Sometimes we provide the products anyway, because it's just the right thing to do. Being in the rehab business is about helping people achieve their highest level of functionality."
About half of the 50 states use the in-the-home restriction in some way, estimates Darren Jernigan, director of government affairs for the wheelchair manufacturer Permobil.
But that's against the law, according to Jernigan, due to a 1999 Supreme Court decision that states a person with a disability must be kept in his or her least restrictive environment. (The Olmstead decision, as it's called, applies only to state and local governments.)
"Medicare has sent letters to the Medicaid programs, telling them they can't use the in-the-home restriction," Jernigan said.
While states like Florida may claim they don't use the in-the-home restriction, they use similar language in denials, said Craig Kraft, director of the seating program at Shriners Hospital for Children in Tampa, Fla.
"They'll say you have to show that a piece of equipment is functionally and medically necessary, but if the beneficiary needs it outside the home but not inside the home, which is the case for a wheelchair tie down, you won't get it," he said.