Louisiana SNFs pick up $8.5M DME tab

BATON ROGUE, La. -- Louisiana Medicaid expects to save $8.5 million this year with a new rule that took effect in July that requires nursing homes to shoulder the cost of customized wheelchairs and other medical equipment. While the savings are notable for the state health department, home healthcare providers say the burden to HMEs and nursing homes will be great. "There are a lot of companies saying they will go out of business because Medicaid was their primary payer source or because they specialized in nursing home supplies," said Wanda Ellis, branch manger of Apnix in Baton Rogue and member of the Medical Equipment Suppliers Association's (MESA) board of directors. Under the old rules, nursing homes paid for standard wheelchairs for residents who needed them. Customized wheelchair orders, on the other hand, were paid for by the state to an HME supplier. A letter from CMS changed all that, said Dr. Fred Cerise, secretary of Louisiana Health and Hospitals. "They said we were an outlier, and that other states had this equipment covered in the nursing facility rates," said Cerise. CMS threatened to cut funding to the state if a change was not made, said Ellis. The new rule, which took effect in July, requires nursing homes to pay for customized wheelchairs and other DME, including ventilators and enteral supplies. To cover the added costs, Medicaid will up the per diem rates paid to nursing homes by about one dollar, said Cerise. Opponents of the change argue that the additional per diem payment -- reported to be 92 cents -- falls far short of to added cost to nursing homes. "If a nursing home has to start paying $5 for enteral nutrition that they are getting 92 cents for, and then the patient needs a customized wheelchair, well, the nursing home is going to feed that person and not waste money on a wheelchair," said Ellis. Cerise said the state remains open to comments about the per diem rate, and that it might be revised in the future. For DME, however, the change could be permanent. The state legislature cut its DME appropriation by half for the coming fiscal year with the understanding that this new program would greatly reduce costs. Cerise said last year alone the state spent $15 million a year on customized wheelchairs for nursing home patients. The state also revised some of its policies related to customized wheelchairs. Now, when a resident dies, the nursing homes retains ownership of the equipment instead of it being turned over to the family.