Darren Jernigan

If a new and ground-breaking Tennessee law effective this month sets a national precedent, rehabilitation credentialing and certification programs may soon be a lot more popular.

The law mandates that by July of next year, all Tennessee providers of long-term use, power wheelchairs employ at least one credentialed rehabilitation technology professional. By 2007, that person must be certified as an Assistive Technology Supplier (ATS) or an Assistive Technology Provider (ATP) or be an prosthetist/orthotist.

Surprisingly, much of the funding and legwork behind the Tennessee bill’s passage came from a manufacturer—the very entity that seemingly would stand to lose the most from a law that limits who can sell wheelchairs. Permobil Inc’s Darren Jernigan, director of government affairs, helped draft the legislation and—with input from doctors, nurses, dealers, therapists, and other manufacturers—pushed the law through the state legislature. Permobil, Lebanon, Tenn, even put up $20,000 to hire a lobbying firm.

“We’re hoping that we can say to a dealer, ‘Look, we only sell to qualified dealers. We don’t sell to the fly-by-night down the street. We’re not going to sell to dealers who are unscrupulous.’ We’re hoping to have that higher rehab core group and market those sales,” Jernigan says. “But I wouldn’t say that was a motivation for pushing the legislation. I’d say it was a by-product that came out of it. Really, it was to professionalize the industry and protect end users.”

Another proponent of the Tennessee law is Jenny Robinson, PT, ATP, a physical therapist in the seating clinic of the Department of Rehabilitation of the Vanderbilt University School of Medicine in Nashville. Robinson helped Jernigan draft and propel the legislation. She backs certification because of personal experiences, such as the time an ALS patient came to her with a chair that had become useless because it was not made to grow with the patient’s condition. However, Medicaid would not provide a new chair because the patient had used up all of the benefit on the first chair.

“It makes so much more work for us—the vendor and the family—to have to grovel for additional funds to pay for something that should have been done right in the first place,” Robinson says.

For rehab equipment dealers who already employ credentialed professionals for seating and positioning, the law will mean little change, but it could impact dealers who provide only one or two chairs per year by forcing them to decide whether they want to sell power chairs. This was one reason why the Tennessee Association for Home Care opposed the law, Jernigan says.

Jay Turner, ATS, a rehabilitation specialist at Holland Medical—a Nashville rehabilitation provider that employs only credentialed staff—says a few companies exiting the high-end mobility niche is not necessarily bad. It will level the playing field for companies such as his.

“You can’t compete with someone who just walks off the street and decides they are going to be able to sell wheelchairs,” Turner says.

Key advocates of Tennessee rehabilitation certification legislation gather at the state capitol to watch the governor sign the Tennessee mobility bill into law. Back row from left: Jay Turner, ATS, of Holland Medical; Jenny Robinson, PT, ATP, of the Department of Rehabilitation of the Vanderbilt University School of Medicine in Nashville; Rep Mike Turner (D); Sen Don McLeary (D); Larry Jackson of Permobil Inc; Keith Dennen of Bone, McAllester, Norton PLLC. Front row (seated): JD Kemp of Holland Medical; Gov Phil Bredeson; Darren Jernigan of Permobil.

Nationwide Standards
Permobil hopes to level that playing field throughout the entire United States. The company plans to spearhead legislative efforts in roughly 15 states, including Florida, Missouri, New York, and Virginia. If credentialing bills pass in 12 or more of those, Jernigan hopes that it will be possible to enact similar legislation on the federal level.

“I would love to see Medicare say ‘no, we are not providing a piece of equipment unless you have been seen by a certified technician,” Turner says. “It only lends credibility to our field.”

But not everyone is so excited about the prospect of another regulatory law.

“The claim that licensing would get rid of ‘unscrupulous’ dealers is not true. The most unscrupulous dealers today are the largest ones,” says Howard Deevers of Able-One Mobility Services, Tucson, Ariz. “What do we have a Better Business Bureau for? What this country needs is not another law.”

But companies such as Permobil and Longmont, Colo-based Sunrise Medical, a proponent of the legislation, believe a law is ideal since manufacturers cannot police the industry alone.

“The best way to raise the level of professionalism is to establish a minimum set of requirements providers need to adhere to as required by the states to ensure a higher level of competency in rehab technology,” says W.B. Mick, vice president of rehabilitation sales at Sunrise. “We feel it is a step toward dealers being viewed more as health care providers and paid for their services.”

Mick says Sunrise is considering teaming with Permobil to advocate similar legislation in other states.

However, Deevers questions the professedly honorable intentions of companies like Permobil and Sunrise.

“Permobil can limit who sells their products now and can require training if they want to. They can provide the training and charge the dealer for that, and I’m sure they will,” he says.

Jernigan says that Permobil will have an educational program to show dealers how to become licensed, and the company hopes to get a grant to help fund the sit-down fee for the certification test.

“Getting people on board is hard because people dislike change,” Robinson says.

However, she and Jernigan are hopeful that opponents will change their minds once they warm up to the idea and see positive results.

Kelly Stephens is news editor of Dealer/Provider.