Page 21 - HME Business, April 2018

GAMES, AAHomecare Stop Ga. Medicaid Cuts
Rapid, cooperative response by associations and industry advocates stops Georgia DCH from basing Medicaid rates on the Medicare fee schedule.
percent of Texas Medicaid from 85 percent for some product categories. The letter offered providers 30 days to accept the rate reductions or lose their status as a participating provider with Superior.
Many providers, however, said they never received the noti cation and some providers, and alleged that the reimbursement rates were below market value, contrary to Superior’s claim in its letter.
As a result, providers in the Lone Star State began working with the Texas Medical Equipment Providers Association (TexMep), as well as other entities to push back. For instance, VGM Group Government Relations organized a provider conference call with providers who were prepared to voice their concern with Superior, Texas HHSC and their elected of cials.
Also, providers engaged legal counsel led by Brown & Fortunato to le a formal complaint with Texas HHSC that showed how the cuts were not re ective of the market, as Superior had contended in its initial noti cation.
“Providers stepped up and answered the call for action by engaging with public of cials to display their opposition to these egregious cuts,” said Collin Brecher of VGM Government Relations. “Texas providers, huddling around the TexMEP state association as a uni ed front, proved to be an extremely effective strategy. While states are looking to trim their budgets, these proposed cuts are going to continue to appear, and providers in all states must remain proactive by building rela- tionships at the state level to prevent these types of harmful cuts from being implemented.”
Following the complaint, Superior posted a notice on its website informing readers that it will not be changing its reimbursement structure for the time being after all.
“Superior HealthPlan is committed to providing cost effective, high quality services and prod-
ucts to our members,” according to the notice. “Based on further evaluation of our recent proposed reimbursement restructuring for speci c medical supplies for durable medical equipment (DME) providers, we are suspending the restruc- turing at this time. We will be working with the Texas Health and Human Services Commision (HHSC) to address DME costs as directed by the 85th Legislature in potentially a different type of provider based initiative at a later date.”
“We are exceptionally pleased that Superior reconsidered their recent plan to cut reimburse- ment and force providers to accept rates below market value,” said Texas Medical Equipment Providers association in a released statement. “This was achieved thanks to many providers who reached out to their Superior representatives, attorneys, and HHS to voice their concerns. As an association, we plan to continue discussions with HHS relating to the value of DME and the issues we encounter as providers.” n
The Georgia Association for Medical Equipment Suppliers (GAMES) with help from
the American Association for Homecare recently succeeding in convincing the Georgia Department of Community Health (DCH) to avoid making tough cuts to Medicaid reimbursement for DME items.
Per the CURES Act, implementation of the plan to limit the Federal matching on Medicaid reim- bursement rates for HME to the Medicare fee- for-service payment rates — including for items impacted by competitive bidding-derived rates — was pushed up from January 2019, to Jan. 1, 2018.
In late December, CMS told state Medicaid programs they had two main options for resolving this:
• Base Medicaid DME reimbursement rates on
Medicare’s fee schedule or competitive bid rates.
• Use both rate and unit utilization data to deter- mine what would be the aggregate reimburse-
ment under Medicare for those same items in order to demonstrate that the state payments are less than the allowable amount.
Georgia DCH initially opted to base its Medicaid rates on the Medicare fee schedule after esti- mating that using the aggregate reimbursement method would result in a $10 million shortfall.
GAMES responded by providing DCH with anal- ysis based on updated CMS guidance that showed the state’s Medicaid program was actually under the aggregate model without incurring any fee schedule changes, according to a report from AAHomecare.
As a result, Georgia Medicaid chief Blake Fulenwider agreed and informed GAMES that patients and providers in the state would not be hit by the cuts that would have come with the simple option of adopting Medicare rates.
Laura Williard, AAHomecare’s vice president
for payer relations, and a GAMES board member, helped the Georgia team craft their arguments and was part of meetings with Georgia DCH. AAHomecare that it worked quickly to clarify which HCPCS codes were impacted by the CURES provisions as part of the effort.
The team approach worked well:
“We appreciate DCH’s willingness to keep an
open mind and work towards a solution that bene- ts both patients and Georgia taxpayers,” said GAMES President Tyler Riddle, also the vice presi- dent of MRS Homecare.
“We’re fortunate to have a partner at the state level who understands the importance of main- taining a viable HME infrastructure to provide cost-effective care that can help keep seniors and people with disabilities in their homes,” said GAMES president-elect Charlie Barnes IV, CEO of Barnes Healthcare Services.
That close relationship was long in the making, according to GAMES executive director Teresa Tatum.
“We’re fortunate that we started working with Blake Fulenwider almost a decade ago when
he was part of Rep. Nathan Deal’s staff in D.C., with HME providers from Georgia engaging
him on competitive bidding and other issues at AAHomecare’s annual legislative conferences,” Tatum said. “It’s a great reminder that the work you put in building credibility with legislators and regulators over time can return important divi- dends in the long run. If we have more providers getting involved in advocacy efforts through their state associations and AAHomecare, I believe we’ll get even better public policy outcomes for our entire industry. n
Texas Providers Fend off Funding Cuts
Organizing and lobbying from state and national stakeholders reversed signi cant planned cuts from Superior HealthPlan.
Medical equipment suppliers in Texas recently banded together to hold
off reimbursement reductions proposed by a managed care company.
Texas’ 85th Legislature requires that the state’s Health and Human Services Commission (HHSC)
reduce Medicaid spending by $830 million and suggests DME rate reviews as one possible avenue of cost savings.
Superior HealthPlan, which administers much of the state’s Medicaid program, proposed in early February to lower reimbursement rates to as much as 60
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