The Definition of Medical Necessity
Dohn Hoyle, Partners in Policymaking Faculty Member, Activist and Organizer
28. The Definition of Medical Necessity
Productivity. Community participation. I don't remember how we worded it but somehow participation, equal participation. And there was one more, I don't remember what it was but you get the gist of them. So it was integration and inclusion in whatever form and whatever it took to attain or maintain that was medically necessary.
And then we waited with baited breath to see what CMS would say to that because they'd had done nothing like that that we'd ever seen anywhere. It came back approved. So under this waiver then you could not only do the kinds of stuff you'd do to ameliorate or prevent the advancement of or whatever you could now whatever it took to attain or maintain community inclusion and participation and all this stuff.
So in every instance, there was either an intent to block it or old stuff blocked it and you had to work on what you could do next. And it isn't for the department to say yes and and turn that in for us. It wasn't just a foregone conclusion because it took a certain amount of political pressure to get to the point of, and a certain amount of what we would bring forward in terms of examples and and what you're trying to do and how it's always important to grab the worst examples of how it was thwarted. Why it made no sense to do that.
So you use some of those examples as to why you should make the change, not just the, what you want to accomplish, but some of the worst examples of thwarting somebody doing something that was very logical And I, those attempts and if you sequence 'em out, you can say, well that's a different place than you were 50 years ago. And so I find necessary to do that occasionally.
So I don't feel too bad about where we are. It's to say, well, we've come a ways, you know, but it is an example of how people can come together and accomplish and work on stuff and make change. And I wish I could say that everybody embraced that change in Michigan but there are places where you'd have to find somebody who even knew there was a change, you know because they, it doesn't look enough different yet. So, so whatever you can do at the state level that's enabling or permissive or whatever there has to be mashed to some extent at the local level by people who are willing to make sure that it happens and hold people's feet to the fire. That isn't always the case.