Tennessee ups the ante

NASHVILLE, Tenn. - Getting claims for certain HME squeezed through the state's Medicaid program requires more and more elbow grease, providers report. Earlier this year, the Bureau of TennCare sent out an exclusion listing, stating that it would no longer cover HME like hospital beds and "specialized" wheelchairs and scooters. It was a move that "shocked" providers, said Gayla Sasser, executive director of the Tennessee Association for Home Care (TAHC). Although the TAHC has convinced TennCare to remove most HME from the listing, providers still report they're submitting more documentation than usual to get equipment approved. "You have to go the extra mile," said Mary Lou Delk, patient services manager for the Jamestown, Tenn.-based Buckeye Home Health Center. "You have to communicate with a patient's physician to get medical records, X-rays, MRIs, scans--you name it." Unfortunately, going the "extra mile" often means Medicaid recipients must wait longer to get "necessary pieces of equipment for their recovery," Delk said. "It's the patients we're worried about," she said. Jeff Carr, owner of Knoxville, Tenn.-based Carr Rehab, agreed that, since the exclusion listing was released, time is the biggest obstacle that providers and patients face. "If you have really good documentation, you're going to get a lot of these items, but it's going to take longer," he said. "It's almost as if the state's denying claims automatically the first go around, but on appeal, you're all set." The TAHC is still working to get TENS units dropped from the exclusion list, Sasser said.