Medicaid considers oxygen therapy cap

Tuesday, June 30, 2009

TOPEKA, Kan.--Medicaid officials notified HME providers recently that they’re thinking about following Medicare’s lead and capping reimbursement for oxygen at 36 months.

The two parties were expected to meet some time in June.

“Nothing’s official, but the state wants more information,” said Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services (MAMES). “They want to know how they would implement a cap and what it might mean (for providers and beneficiaries).”

Medicare’s oxygen cap kicked in Jan. 1, 2009. Since then, some providers have reported having to cut back on services, negatively impacting beneficiaries.

An oxygen cap for Medicaid might have even more of an impact than the cap for Medicare, says provider Gary Miller.

“It’s a different clientele,” said Miller, director of Mt. Carmel Medical Equipment in Pittsburg, Kan. “They tend to be younger; they tend to be more ambulatory; and they tend to be on oxygen for longer than three years. They’re more heavily dependent on our services.”

Providers plan to go into the meeting prepared. If Medicaid officials say they must cut oxygen, for example, they need to have something to put on the table, they say.

“We’ll likely go over where they could save money and where they couldn’t,” said Sheila Roberson, office manager for Criticare Home Health Services in Lawrence, Kan.

At least it appears Medicaid officials are giving providers a voice in the process, providers say.

“We’re happy about that,” Miller said.