Maine: Providers, Medicaid compromise

Thursday, October 22, 2009

AUGUSTA, Maine – Providers here met with Medicaid in September to hammer out a new fee schedule—code by code.

“We argued over every penny,” said Jim Greatorex, president of Portland-based Black Bear Medical. “But, we got the best fee schedule we felt we had a chance of getting.”

The new fee schedule is the culmination of several months of back and forth between providers and MaineCare, the state’s Medicaid program. On the table at various times: an across-the-board reimbursement rate set at 74% of current Medicare allowables; and a cost-plus system of reimbursement, both of which would have been “killers,” said Greatorex.

The two sides compared average payment data from 2008 and discussed areas for savings. Savings found in certain categories were applied to others where a payment reduction could impede beneficiary access. For example: Incontinence wipes will no longer be covered at all. On the other hand, MaineCare will pay for oxygen at 100% of the Medicare allowable.

With more than 1,200 HCPCs codes, it was, to say the least, “complicated,” said Greatorex.

Greatorex credits the state with bringing in a mediator and an actuary to smooth what has at times been a contentious process.

“That got us so we were speaking with each other and negotiating and hearing each other out,” he said. “This was by far the most cooperative it’s been.”

The new fee schedule was slated to take effect Oct. 1, pending approval after a public comment period.