Stakeholders secure repair reform in Tennessee

NASHVILLE – A bill that has passed in the Tennessee General Assembly provides “model legislation” for securing coverage and payment for preventative maintenance for complex rehab wheelchairs and paves the way for a larger effort on repair reform, stakeholders say. 

The bill requires the state Medicaid program, TennCare, to cover and pay for preventative maintenance once a year, in a move that would help to address the difficulties that some wheelchair users are experiencing getting timely repairs. 

“This moves us in the right direction,” said John Goetz, senior advisor, Bridge Public Affairs, who has been retained by AAHomecare to work on CRT and DME strategies in Tennessee over the coming months. “We’ve been working, as an industry, to come up with what are the things that we can do to help users get access to more timely repairs, and we think we came up with model legislation here.” 

At press time, the bill, which will go into effect July 1, was awaiting the governor’s signature. 

A big reason stakeholders consider the bill a “model” is the involvement from the get-go of the Tennessee Disability Coalition. They partnered with the coalition, first working last year to remove the prior authorization requirement for repairs and now to add a preventative maintenance requirement. 

“This is a user-focused bill, driven by the coalition,” said Goetz, whose father is a wheelchair user. “The industry is supporting the users in this group. We’ve not had that in a lot of the other bills being worked on around the country.”  

The bill also establishes the right of the consumer to self-repair and purchase certain parts directly from the manufacturer and requires provider to “service what you sell.” Stakeholders and the coalition did have to streamline the bill to apply only to TennCare and not commercial payers. 

“We can’t let perfect be the enemy of the good,” Goetz said. “This gets us 90% of the way there and once we have the benefit, it will be hard for the commercial payers not to do it.” 

The challenge in many states in getting preventative maintenance covered and paid for is the lack of Medicare coverage for the service, and this win in Tennessee gives the industry’s larger efforts more momentum, stakeholders say. 

“Most payers look to Medicare and there’s nothing,” said Alexis Ward, senior director of payer relations for AAHomecare. “That’s something that has gone back decades: The provider is just expected to absorb those costs, which has exacerbated the issues with repairs. We’re trying to identify where we can get these small wins and then go to CMS to say, ‘Let’s talk about this.’”