Medicaid delivers mixed bag

Wednesday, February 28, 2007

WASHINGTON - The rehab industry's plea to state Medicaid programs to accept Medicare's new allowables for power mobility devices at face value has garnered a variety of responses.
Although NCART doesn't have a "written tally," Sharon Hildebrandt, executive director, said states have decided to do everything from paying 100% of the Medicare allowable to paying 70% of the allowable.
"We're still trying to educate directors on how the fee schedule is already a reduction, and we're having trouble getting through to some of them," she said. "Everyone has different worksheets that they're working from."
NCART launched a campaign in late December to educate state Medicaid directors about the dangers of reducing Medicare's allowable (See HME News February 2007).
TennCare appears to be the state Medicaid program that has been the least receptive to the industry's pleas. The two companies that administer the program for middle Tennessee, AmeriChoice and AmeriGroup, plan to pay only 40% and 65% of the Medicare allowable, respectively, according to Darren Jernigan, director of government affairs for Lebanon, Tenn.-based Permobil.
As a result, providers in Tennessee have rallied together to draft a bill that would force TennCare to pay 100% of the Medicare allowable, as long as providers have a RESNA-certified rehab professional on staff. The bill was introduced in the state's House of Representatives in early February.
"Few providers in Tennessee are signing contracts with Medicaid--they're outraged that TennCare came in so low," he said. "Federal law states that Medicaid must have provider networks, and TennCare doesn't have much of one."
In a different twist, the state Medicaid program in Ohio has told providers that it needs to wait and see what private payers do with Medicare's new allowables, according to Kam Yuricich, executive director of the Ohio Association of Medical Equipment Services (OAMES).
"They've indicated to us that they have to be the lowest payer," she said.
Providers and OAMES have now found themselves in the difficult position of trying to reach out to private payers--"We don't have a strong presence in that world," Yuricich said.
Paul Bergantino, president of the Naperville, Ill.-based ATG Rehab, has lobbied various state Medicaid directors and private payers to pay 100% of Medicare's new allowables. Both have been hard sells.
"You have to cover a lot of ground in an hour meeting," he said.