Medicaid backs off policy changes

Saturday, February 28, 2009

ATLANTA--Following an outcry from rehab providers, the Georgia Medicaid program rescinded its plan to eliminate a seating and modification code and reduce allowables.

On Jan. 23, Medicaid backed off the 2009 policy changes released at the beginning of the month until further notice. It’s a good sign, providers say, that Medicaid is at least willing to listen and work with the provider community.

“It showed they understood that we could no longer provide services to clients if we didn’t know what we were going to get paid for or if we did get paid, we didn’t know how much,” said Weesie Walker, manager of National Seating & Mobility in Atlanta.

Medicaid’s 2009 policy manual eliminated the K108 code, a miscellaneous code used frequently by providers for special equipment, including growth kits, positioning backs, specialty electronics, headrests and lateral supports.

“They took the ability to provide anything other than cookie cutter (equipment) away from us,” said Scott Scobey, president of Low Country Mobility in Savannah.

Additionally, Medicaid proposed reducing allowables, in some cases below provider costs, Scobey said. For example, reimbursement for a power tilt system, with a M.S.R.P. of $4,500, was reduced to $3,200, he said.

“We can’t supply it at a loss,” he said. “Medicaid recipients require a lot of aftermarket services and the answer cannot be suppliers funding it.”