Even as the battle to stop competitive bidding continues to dominate the minds of providers, state associations are pressing on in their efforts to pass licensure legislation. And, unlike competitive bidding, which has seen few clear-cut victories for providers, licensure continues to be a bright spot.

New York offered up the latest victory when Governor George Pataki signed legislation passed by the New York State Senate and Assembly on October 2, making the Empire State the most recent inductee into the growing fraternity of states requiring that HME providers be licensed to do business.

Not every licensure effort in 2002 was successful. South Carolina, Rhode Island, and Ohio all encountered roadblocks or delays on their way to regulation. But, undeterred, the state associations are continuing their efforts to get licensure passed.

This commitment to licensure reflects efforts by the industry to raise the level of professionalism, say state association leaders. “I was just at Medtrade this week...sitting at a roundtable with the other state executives, and when we announced we had licensure, there was a round of applause,” says Jackie Negri, executive director of the New York Medical Equipment Providers Association (NYMEP).

Pataki’s signature on New York’s licensure bill culminated a 7-year effort by NYMEP to establish regulations for the HME industry in the Empire State. The industry wants to keep the profession honest, says Melissa Pugliese, counsel for Senator James Alesi (R-Monroe County), lead sponsor of the New York State Senate’s version of the bill. “They felt they wanted to be regulated, I think, to add some credibility to what they do,” she says. “And it keeps people from holding themselves out as certified or as knowledgeable individuals when, in fact, they may not have the training that is needed or associated with that type of profession. Most businesses or associations out there right now do not want to be regulated. [They think] it is more hassle than it is worth, so to have a group that actually wanted to be regulated was a little odd.”

Not only did NYMEP want regulation to improve the status of the HME profession, but it also wanted to make sure providers were delivering good products along with good customer service. The group worked in partnership with the New York State Department of Health to hammer out a bill that would make sense to the industry, consumers, and legislators. Negri credits the successful passage of the law to NYMEP’s leadership, its lobbyists, and legislative leaders. “We took a look at the way the original language was written and worked the language so that it works best for providers and consumers,” she says. “[Consequently, our bill] sponsors were very strong in sending their message to their colleagues, and that is why it moved over the past year and half in order to be signed.”

Among other provisions, the law requires providers to employ adequately trained and supervised personnel, develop a quality assurance program, provide education and assistance on the proper use of equipment to patients and their caregivers, and pay a triennial licensing fee of $1,150. In addition, it will create a Medical Equipment Service Agency Advisory Board and NYMEP will make recommendations about the appointments to this board.

Though the bill was signed into law, there are still details in it that have to be finalized. Pugliese says that there are several amendments to the law that will be added in the near future. “I believe in December we wil be doing a chapter amendment because the regulatory fees in the bill are not going to cover the actual expenses of setting up the regulations,” she says. “And there needs to be a change to protect the respiratory therapist profession.”

The law will also allow disputes between providers and patients to be dealt with administratively, making the resolution process much more efficient. Disputes regarding care will be handled by a hearing officer in the Department of Health, thus bypassing the court system. Pugliese says that the administrative recourse will give both providers and their clients protection under a set of explicit, well-defined rules. “It doesn’t leave any gray areas,” she says.

The passage of the law has made New York a trendsetter in licensure efforts. It is a mantle NYMEP is gladly taking on. “Hopefully, we’ll be able to assist other states in this effort,” Negri says.

South Carolina Update
Not every state association has had the same good fortune as New York. The South Carolina Medical Equipment Services Association found its efforts stymied for the oldest reason in the book—politics. The administrator of the board of pharmacy began rewriting the provisions of the bill, slowing its progress to the legislature. “[The administrator of the board of pharmacy] held it up long enough in trying to do these revisions until we really ran out of time in the session,” says Bobby Horton, executive director of the South Carolina Medical Equipment Services Association. “At the end of the session he quit, but I found out he had committed to the job for only a year and he didn’t want to deal with the thing.”

Though hitting a roadblock, Horton is confident the legislation will pass next year, because it is reasonable and helps to curb fraud. “Legitimate DME dealers have no problem with the state licensure bill,” he says. “It raises the level of professionalism of the DME industry.”

New England and Ohio
New England’s efforts did not fare much better than South Carolina’s. Connecticut’s legislation, which was introduced in 2001, is meeting with resistance from the pharmacy industry. Activists in that state are in the process of regrouping to press forward in next year’s legislative session.

In Massachusetts, Maine, and Vermont, there has been no movement forward. In New Hampshire, a regulation change to its licensure law excludes DME companies from being licensed, something the New England Medical Equipment Dealers Association [NEMED] is trying to change.

“As it stands right now, in New Hampshire you don’t need an HME license,” says Karyn Estrella, executive director of NEMED. “We’re hoping that once the new regulations go into effect, they will have included our language that would have required licensure for DMEs.”

In Rhode Island, where regulations were passed in lieu of licensure, DME has since been excluded from the regulations, putting the state’s providers in a sort of licensure holding pattern.

With all of the seesawing between being regulated and excluded from regulations, Estrella is undaunted, convinced that licensure is worth pursuing. “We want to level the playing field so everybody is abiding by the same standards,” she says. “This is going to help protect the legitimate providers from the people who have a Medicaid or Medicare number and are working out of their garage.”

Ohio also stumbled in its efforts to pass licensure during the 2002 legislative session. Kam Yuricich, executive director of the Ohio Association of Medical Equipment Suppliers, is taking the setback in stride. The Ohio bill will be reintroduced next year.

Clearly, for those states pursuing licensure, the issue will not be dropped until they can resemble New York.

C.A. Wolski is associate editor of Dealer/Provider.