Kansas: Medicaid to adopt competitive bidding pricing

Thursday, October 28, 2010

TOPEKA, Kan. - The other shoe has dropped in Kansas.

The state Medicaid program in September notified the Midwest Association of Medical Equipment Services (MAMES) that it plans to adopt competitive bidding pricing on Jan. 1. The good news: It doesn't look like it will apply the pricing--on average, 32% below the current pricing for nine product categories--across the board.

The way stakeholders understand it, the state plans to apply the pricing only for dual-eligible beneficiaries who have both Medicare and Medicaid coverage, and for beneficiaries who live in the Kansas City competitive bidding area.

"But we're still waiting to see that in writing," said Rose Schafhauser, executive director of MAMES, in September.

The state also tried to apply competitive bidding pricing in 2008, when CMS started and then stalled the program.

Another thing stakeholders are waiting to see in writing: Whether or not the state plans to require that beneficiaries get equipment like oxygen concentrators and power wheelchairs only from winning bidders.

Stakeholders aren't surprised that the state plans to adopt competitive bidding pricing. Kansas, like other states, is hurting for money and it's not afraid to target DME for cuts. Earlier this year, the state applied a 10% cut to pricing for most DME.

But stakeholders say the state's actions will come at a cost.

"The fact that they're going to apply the bid rates, especially given that they're obscenely low, will cause a lot of companies to stop doing Medicaid," said Sheila Roberson, the office manager at Criticare Home Health Services in Lawrence, Kan. "We already refuse a lot of patients. I don't think they grasp the whole effect."

Meanwhile, rumors continue to swirl that other states will also adopt competitive bidding pricing for their Medicaid programs.