Licensing of hme providers by state governments is a controversial subject. After all, between accreditation organization requirements, Medicare and Medicaid supplier standards, and business licenses, it is easy to argue that the industry is already heavily regulated. Why would anyone work to get an added level of government oversight?

However, advocates say that state licensure can be a powerful tool in closing the loopholes that allow dishonest providers to operate—taking business away from legitimate providers and blackening the industry’s name. Plus, when the request for state licensure comes from members of the HME industry itself, the industry retains more control over the final form the legislation takes. If the industry waits for an overly officious legislator to notice that most states require a special license for hairdressers, but not one for HME providers, it may be too late to impact the writing of the law, advocates say. “I think association involvement is critical. The industry needs to be involved from the get go,” says Alan Cross, president of C&C Homecare, Bradenton, Fla, and spokesperson for the Florida Association of Medical Equipment, which obtained licensure in 1999.

The American Association for Homecare (AAHomecare) tracks state licensure of HME providers, but does not have an official position on the subject. Instead, it acts in an advisory role, helping local associations navigate the legislative process.

To get as complete a picture of the state of licensure of HME as possible, Dealer/Provider began with AAHomecare’s information and then contacted the state associations (or state governments in states without associations) to survey who had licensure and what form it took in their state. We heard from all but six states. Of the states that responded, 13 had some form of licensure, either as a separate law or as an extension of an existing law, such as pharmacy or medical device manufacturer regulation. In addition, seven states and the District of Columbia had industry organizations that were pursuing licensure for their state.

Among those states with licensure, the industry response was favorable. “[Licensure] has made it a better place. It has stopped people [operating] from the backs of cars,” says Alcia Moore, president of the Mississippi Association of Medical Equipment Services (MAMES). “It is not that we want anyone to go without meals or anything; it is just that the patients deserve it. They are the beneficiaries and they deserve the best for their dollar. That’s what we want to do.”

Gayla M. Sasser, executive director of the Tennessee Association for Home Care, which also has licensure, adds, “Our goal was to promote standardization and raise credibility for the industry, and as best I can tell, that is working.”

For some, it took years to achieve the legislation. Others got it in a matter of months. And some are in a holding pattern waiting a more favorable political climate. “We’ve met with the Governor [Rich of Pennsylvania], and he let us know that as long as he was in office, we would not be able to get licensure—and he is still in office,” says Claire Turner, executive director of the Pennsylvania Association of Medical Suppliers (PAMS).

States with Licensure
Alabama
Administering office: State Board of Pharmacy
When enacted: May 2000. Went into effect September 1, 2000
Details of law: Providers must obtain a permit and register annually with the Board of Pharmacy. In addition, providers must sign an affidavit that says they comply with the state’s standards for HME providers. The North Carolina Association for Medical Suppliers is currently seeking approval of the “Out of State Licensure” bill (SB 473) to ensure out-of-state HME providers obtain a permit and register annually as in-state providers are required to do.

Arkansas
Administering office: State Board of Pharmacy
Details of law: Providers must comply with the state’s standards for HME, legend devices, and/or medical gases retailers; pay a fee of $250 or less; and display their license in a conspicuous place. The license must be renewed by December 31 of each calendar year. Penalties are assessed to companies that do not renew by the 31st.

California
Administering office: State Department of Health Services.
When enacted: September 29, 2000. Went into effect July 1, 2001.
Details of law: Providers must comply with the state’s standard for the safe and professional handling and storage of medical equipment and have written equipment and personnel policies. Out-of-state providers also must be licensed by the state or operate through an in-state licensed wholesaler. The law is in effect until July 1, 2003.

Florida
Administering office: State Health Agency
When enacted: Approved by Governor on May 26, 1999. Went into effect July 17, 2001.
Details of law: Providers must verify that they are accredited and insured. Employees must have received background checks before they were hired and the company must report who its owners are.

Idaho
Administrating office: State Board of Pharmacy
When enacted: 1997
Details of law: Providers must have a physical storefront, yearly inspection of the premises. Licensing fee is $50.

Illinois
Administering office: Illinois Department of Professional Regulation
When enacted: 2000
Details of law: Providers must complete licensure application. Yearly inspection. Each company location must be independently licensed. Licensing fee of $300.

Maryland
Administering office: Maryland Department of Health and Mental Hygiene
Details of regulations: License fee of $25.

Mississippi
Administering office: State Board of Pharmacy
When enacted: 1998
Details of law: Certification, storefront/facility must be clean and orderly, maintenance records must be kept for all equipment.

Nevada
Administering office: State Board of Pharmacy
When enacted: September 14, 2000
Details of law: Board of Pharmacy extended its rules and regulations to the HME industry. Providers must obtain a medical devices, equipment, and gases (MDEG) license by April 1, 2001, to remain eligible to participate in the Nevada Medicaid program. This involves an inspection visit by the Board of Pharmacy.
New Hampshire
When enacted: 1991
Administering office: Department of Health Services
Details of law: Requires an annual inspection. Providers must have a complaint policy in place, and maintain care, maintenance, and personnel records. Yearly license fee is $20.

North Carolina
Administering office: State Board of Pharmacy
When enacted: 1995
Details of regulations: Providers located inside and (since 2000) outside North Carolina must apply to the State Board of Pharmacy, including presenting evidence in the form of photographs of physical storefront. License costs $350 per year.
“Everybody in the country seems to call us about [licensure] because we were the first ones to do it.”
—Beth Bowen, North Carolina Association of Medical Equipment Services.

Tennessee
When enacted: 1995
Administering office: Health Facilities Division of the Department of Health
Details of law: HME providers are surveyed annually for re-accreditation. Already licensed companies that also are accredited by an accrediting body, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), can apply that accreditation in place of a survey by the Department of Health. However, the Department of Health reserves the right to survey a company at any time.

Texas
When enacted: 1994
Administering office: Texas Department of Health
Details of law: Medical device distributors must be licensed under the same law that governs manufacturers of medical devices, the Licensure of Device Distributors and Manufacturers (§229.431) law. The license must be renewed annually and requires proper facility and records maintenance to protect employees and customers.

States Seeking Licensure
Connecticut
Bill number: General Assembly Raised Bill No. 6764
Details of bill: Will require providers to comply with Centers for Medicare and Medicaid Services supplier standards, train employees appropriately, maintain clinical records, and establish equipment and personnel policies. Referred to Committee on General Law.

District of Columbia
In preliminary discussions with the District’s health agency.

Massachusetts
In the process of pursuing. Karyn Estrella of the New England Medical Equipment Dealers predicts that Massachusetts will be the next state with licensure.

Montana
In the process of examining options for licensure.
“I am a firm believer that if you’re going to shoot for state licensure, I think you need to look for an existing entity before lobbying for state licensure of HME companies. We are currently looking once again at the State Board of Pharmacy. When you already have inspectors in places, and licenses and everything else, it just makes good sense to look at an entity that’s already doing it, and it makes it much easier to pass it through [the legislature].”
—Troy Paz, president, Big Sky Association of Medical Equipment Services.

New York
Name of bill/bill number: The Home Medical Equipment Licensure Bill (S.2218/A.3116)
Status of bill: Legislation failed to pass prior to recess and will be resubmitted for the 2002 legislative session.
“We think it will definitely be considered next year.”
—Jackie Negri, executive director, New York Medical Providers Association.

Ohio
Legislation is being drafted. The Ohio Association of Medical Equipment Services (OAMES) has hired lobbyists to assist in passing the legislation.

Rhode Island
In lieu of licensure, state has issued regulations covering HME providers.

South Carolina
Name of bill/bill number: S.470/Home Medical Equipment and Services
Status of bill: Was reintroduced in February. The Senate Labor, Commerce and Industry Committee is reviewing it. Later, it will be sent to the House Medical, Municipal and Military Affairs Committee.

“We really don’t have any organized opposition to the bill, and there’s no reason why it shouldn’t fly when the session cranks back up in January. Every legislator we have talked to is in shock almost that there is no oversight in this industry in South Carolina.”

—Bobby Horton, executive director South Carolina Medical Equipment Services Association.

To see where your state stands, read on. For more information, contact your state association or AAHomecare, 625 Slaters Lane, Suite 200, Alexandria, VA 22314; (703) 836-6263; info@aahomecare.org.

C.A. Wolski is associate editor of Dealer/Provider. Lena Lindahl is senior editor. Both wish to thank AAHomecare and the many state associations that contributed to this report.