Stakeholders eye 'new tool' for standers

Friday, April 24, 2015

NASHVILLE – After getting Tennessee’s Medicaid program, TennCare, to pay for elevated seating and standing systems on power wheelchairs, Darren Jernigan is setting his sights on other states. 

The items were on a list of DME products TennCare refused to cover, a violation of CMS’s DeSario letter, which prohibits such exclusion lists. 

“We (got them covered) using a new approach,” said Darren Jernigan, director of government affairs at Permobil and a member of the Tennessee House of Representatives. “As a state representative, I have the right to ask for an opinion from the Tennessee attorney general on whether or not it was legal for TennCare to exclude these items.”

Jernigan presented the letter in January 2014 to the attorney general, who suggested he and Jernigan discuss the issue with TennCare before the attorney general issued a formal opinion. Rather than open itself up to a lawsuit, TennCare changed its policy later that year.

Jernigan says he intends to use the same tactic in other states with exclusion lists, like North Carolina.

“We’re really looking at elevated seats and power standing because it clearly falls under the DeSario letter,” he said. 

NCART Executive Director Don Clayback says the approach could also be used to persuade Medicaid policymakers on other state issues.

“We’ll certainly incorporate that into our strategy,” he said, “Whenever we hear about something that’s working, we want to make sure we add that to our tool box.”