MCO bill becomes law in Kentucky

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Friday, April 5, 2019

FRANKFORT, Ky. – Kentucky Gov. Matt Bevin has signed into law a bill that streamlines DME regulations and reimbursement policy for the managed care organizations managing the state’s Medicaid program.

The bill ensures that MCOs:

  • Reimburse DME suppliers by at least 90% of the rate set by the Kentucky Medicaid program;
     
  • Requires that specialty items not listed on the current fee schedule be reimbursed at the manufacturer’s suggested retail price minus 18% or at invoice cost plus 20% when there is no MSRP, and eliminates the ability of MCOs to take any discounts; and
     
  • Requires that MCOs provide coverage for the same codes and the same quantities of medical supplies, equipment or services as established in the fee schedule for Kentucky Medicaid.


The law has its roots in a bill, HB 224, that was first passed by the House of Representatives in February.

“The provisions in HB 224 will go a long way toward helping reduce the cuts providers received last year due to the Cures legislation,” said Laura Williard, vice president of payer relations for AAHomecare. “This bill will put $7 million back into the pockets of Kentucky DME providers so they can continue to provide excellent care and keep patients in their home.”

In March, the Senate passed an amended version of the bill, followed by the House.

“By stabilizing Medicaid reimbursement rates and clarifying regulatory policy, Kentucky lawmakers are providing a more sustainable business environment for DME suppliers who serve Medicaid beneficiaries, many of whom face profound health challenges,” said Teresa Aldridge, executive director of the Kentucky Medical Equipment Suppliers Association.