Medicaid and used durable medical equipment

One year ago, Alaska joined the ranks of Texas and Kansas in passing legislation to allow Medicaid reimbursement for used durable medical equipment (DME).  An update in the April 2016 issue of Home Medical Equipment News finds that supportive legislation to actually implement the bill is yet to come!  Residents and suppliers are still waiting.

The bill may require Medicaid beneficiaries to purchase used or refurbished DME if, “the equipment is available; less expensive; is able to withstand three years of use; and meets the needs of the recipient.”  Clearly the law is intended to save money for the Medicaid system and not necessarily protect and provide for the person receiving the equipment.

DME providers are concerned about additional paperwork and audits that would tie up their shrinking resources with mounting government red tape already on the books.  Many questions remained un answered:

  • Who honors the warranties and makes the repairs?
  • What about sanitation issues and liability?

These issues appear to have stalled implementation of such programs in all three states to date.

Thoughts from an O.T.

Often I have searched the back shed of a rehabilitation facility, used equipment closet, or the lending closet of various charities and organizations to search for free stuff for my patients.  Most of the time the items were stained by something nasty, dirty, or unmentionable!  Often there were scratches in the materials that could lead to a skin abrasion if just the right care was not taken in its use.  Suction cup footers can be missing; a retractable pin for making height adjustments might be bent or missing as well.  The list goes on.  We made the best selections and decisions possible in each circumstance, trying to locate or get someone to purchase the missing parts and sanitize the equipment as best we could before issuing it to our patient.  We tested it for safety and completed training in our occupational therapy visits then sent the happy patient on his or her way.  I often wonder what happened later . . .

We probably should have prayed more!  Flash forward 4 years from my last home health care visit and the accumulation of a boatload of knowledge about environmental hazards (can you say mold?) that can plague virtually any living environment.  Some surfaces will never come clean from the mycotoxins that make a person sick from mold.  Mold, like noxious chemicals, are everywhere.  While we might say that providing the equipment was, “better than nothing,” we might also remind ourselves that by issuing that equipment as a healthcare provider, we were endorsing to the patient that it was in good and working order.  And we are assuming some measure of liability in the process.  That, dear friends, is not within the realm of a State license for an occupational therapist or occupational therapy assistant!  A statement like that comes from the store that sold the item long ago to someone else or even to the manufacturer who made it in the first place.

Things are probably better when a family member goes and picks up, picks out the equipment when it is used.  I am really not sure about this.  I recall when the director of a home health care agency for which I was working suddenly asked us to clean out our inventory of new/demonstration bathroom safety equipment.  We were horrified!  What were we going to show our patients?  A photocopied picture of a tub transfer bench when they knew that a shower chair from Walgreens was cheaper (but inadequate for their needs)?  My whole career was spent demonstrating real-life equipment in real-life situations so the patient and their families could see and feel, build confidence, and then go ahead and get the items that they needed.  It was a tough transition indeed.

But our director, Betty was right.  We were assuming too much liability by transporting equipment from one house to the next.  Those items had started out “new” but over time became “used.” Transporting then sanitizing them every single patient treatment visit consumed precious time, and sometimes still wasn’t exactly what the patient needed.  The best scenario turned out to be referring a family to the showroom of a local home medical equipment provider where everything was available for them on display.  Sometimes this did all come together and sometimes not.  Most of the time we bumbled along with some of us pirating our own stash of 3-in-1 commodes, reachers, leg lifters, and more.

I think that basically Betty did not want to see the stuff in our office . . .  It took up a lot of space that in time we did not have when we moved to a new location.  I think there probably is still a tabletop arm bike and raised toilet seat in the trunk of one of my co-worker’s car!


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