Massachusetts: Proposal could cut out new providers

Tuesday, May 26, 2015

BOSTON – Massachusetts’ proposed Medicaid budget for fiscal year 2016 raises more questions than it answers, say DME stakeholders.

Under the proposal, the state’s Medicaid program, MassHealth, would be allowed to contract with DME manufacturers and distributors, bypassing providers. 

“At this point, the language is fairly vague and it doesn’t have a specific plan in place, which is a concern for providers, because we don’t know where that leaves us,” said Peter Tallas, president and CEO of Pembroke, Mass.-based Charm Medical Supply.

The proposal does not specify which DME products could fall under the provision or what form those contracts would take. It’s also left providers wondering if the state even understands how the DME supply chain works.

“We heard (MassHealth) was thinking about buying diapers in bulk, but where are they going to store it?” said Karyn Estrella, president and CEO of Home Medical Equipment and Services Association of New England. “How are they going to deliver it to the patients? How are they going to qualify people before they deliver the product?”

Cutting out providers could lead to spending increases in unexpected ways, they say.

“We’re the gatekeepers of Massachusetts Medicaid spending,” said Bill Fredericks, president and CEO of Millbury, Mass.-based All Care Medical Supply. “We’re the ones that overlook the prescriptions to see if they’re medically necessary. If that process is taken out, it’s going to be open season.”

The House passed the budget in late April; the Senate was expected to release its own version of the budget in May.