Maine: Medicaid programs rescinds bid-related cuts

Friday, August 19, 2016

AUGUSTA, Maine – HME providers were ready for a fight with Medicaid officials over recent reimbursement cuts, but they were pleasantly surprised it turned out to be mostly unnecessary.

At an Aug. 2 meeting with members of the Home Medical Equipment and Services Association of New England, MaineCare officials said they planned to revert to the December 2015 fee schedule.

“They told us they will change the rates, hopefully in the next few weeks, and they will adjust all claims retroactively going back to Jan. 1,” said Karyn Estrella, president and CEO of HOMES.

So what happened? In Maine, Medicaid by law is not allowed to pay higher than Medicare rates, so when its billing and payment system automatically uploads fee schedules—something it does frequently—it “grabs” the lowest rates, says Estrella. When the fee schedules reflected two rounds of Medicare reimbursement cuts of 25% each, on Jan. 1 and July 1, it grabbed those, too.

The change back to the December 2015 fee schedule isn’t effective immediately. Making the changes requires a rulemaking process that typically takes 120 days.