Illinois: Providers, Medicaid hammer out proposal

SPRINGFIELD, Ill. - Industry stakeholders in May planned to meet with Medicaid officials to discuss their proposal for saving money without drastically impacting providers or beneficiaries.

The state had originally proposed completely eliminating the Medicaid benefit for all home medical equipment and supplies for adults, beginning July 1, then reversed gears and proposed an across-the-board cut of 10%. The move came as the state grapples with a $217 billion budget gap.

Enter the Illinois Association for Medical Equipment Services (IAMES), which figured that it could help find targeted savings, rather than simply slashing reimbursement across the board.

“We thought there was an ability for us to partner on some long-term strategic cuts to prevent that shift in healthcare costs from an outpatient program to an inpatient facility,” said Neidi Mack, president of IAMES.

Using data that tracked spending by HCPCS code for the past two years, six subcommittees made up of IAMES members hammered out a proposal that included, among other suggestions, reducing reimbursements or allowed quantities for some codes, and tightening up some eligibility requirements. For example, reducing the quantity allowed for diapers, liners, pull-ups and briefs from 300 per month to 240 per month; increasing age eligibility for certain incontinence products from two to four; and allowing a 90-day replenishment for diabetes supplies instead of 30 days.

Members were still trying to work out solutions for a few product categories, including complex rehab.

“We've come up with what I think is a very fair proposal,” said Ty Bello, executive director of IAMES. “We've been finding that they have been wonderful to work with.”