Medicaid grasps at NCB reimbursement

Saturday, May 31, 2008

COLUMBUS, Ohio--It took Ohio Medicaid less than a week to pick up on national competitive bidding reimbursement.

On March 24, three days after CMS released competitive bidding reimbursement, Ohio Medicaid proposed paying providers about $105 per month for oxygen concentrators, about 80% of $130, the reimbursement set for Cincinnati, one of the Round 1 areas.

“We’ve talked about the trickle down effect of competitive bidding, but it was scary how fast this happened,” said Johnny Miller, treasurer of the Ohio Association of Medical Equipment Services (OAMES) and homecare manager for Miller’s in Akron, Ohio. “It sets a dangerous precedent.”

Before competitive bidding pricing was released, Ohio Medicaid had proposed reducing reimbursement for concentrators to $81 per month from $178. It proposed the cut after auditing two providers that provide concentrators to nursing facilities.

While $105 is better than $81, it’s still not “doable,” Miller said, and providers will have to cut services.

That’s what providers told Medicaid officials at a hearing on May 5. Providers also told officials that using competitive bidding reimbursement for Medicare and applying it to Medicaid and the whole state is “flawed methodology.”

“It’s not apples to apples,” Miller said.

In the weeks following the hearing, providers expected Ohio Medicaid to do one of two things: revise its proposal based on comments; or finalize it’s proposal and turn it over to JCARR, a legislative committee that reviews rules before they’re implemented.

“We’re talking to legislators,” said Joe Petrolla, a member of OAMES’s board of directors and vice president of sales for Seeley Medical in Andover, Ohio. “This doesn’t make sense on so many levels.”