MassHealth frowns on equipment closets

Thursday, March 24, 2011

BOSTON - Providers here learned in December that the state Medicaid program doesn't think providers should participate in loan and consignment closet arrangements.

The issue came to light after MassHealth, the state's Medicaid program, audited providers participating in loan and consignment closets with physicians.

Because under such an arrangement, the HME provider is delivering the items to the physician, rather than directly to the patient, they are not eligible for Medicaid reimbursement, says the state, which is recouping payments.

"They are saying that the reimbursement to the provider includes delivery and education," said Karyn Estrella, executive director of the New England Medical Equipment Dealers association (NEMED).

That's too bad: Loan closets have been especially helpful for pediatricians treating young respiratory patients, Estrella says.

"It's such a relief for the family to leave the doctor's office with the equipment they need," said Estrella.

If it ain't broke, don't "fix" it, say providers.

"This is something that has been done effectively for a number of years," said one provider who didn't want to be named for fear of triggering an audit. "It allows them to treat and manage an infant in distress, but (Medicaid) is insisting now that mom take the sick baby, leave the doctor's office--which has to send the referral--and arrange for a visit, which is not always easy (to do right away)."

NEMED has asked its members to collect signatures or letters from physicians and other clinicians asking the state to reconsider.

"The doctors are saying this has been a great tool for us to reduce ER admissions," said Estrella. "It's just not good clinical practice to stop doing this."