Medicaid madness

Monday, August 24, 2009

TRINIDAD, Colo. – With some complex rehab providers relying on Medicaid for up to half of their business, NRRTS has formed a committee to take stock of reimbursement rates and policies in different states.

“It used to be that complex rehab providers could say, ‘To heck with Medicare; I’ll just deal with Medicaid and private insurances,’” said Simon Margolis, NRRTS’s executive director. “But that part of their business has gone to heck, too.”

Medicaid has gone to heck, Margolis and others say, because Medicaid programs in different states are adopting Medicare’s reimbursement rates and policies, like the 9.5% reimbursement cut that went into effect Jan. 1. Some programs take it a step further, paying only a percentage of Medicare’s reimbursement rates.

Currently, the committee seeks at least one volunteer NRRTS registrant or friend of NRRTS (FON) from each state to submit monthly reports on reimbursement rates and policies. It has volunteers from seven states so far: Florida, Georgia, Louisiana, Michigan, Pennsylvania, South Carolina and Tennessee.

NRRTS will use the reports to identify trends in reimbursement rates and policies, and to lobby for changes.

“Some states have poorer reimbursement than others,” said Michelle McMahon, a NRRTS registrant who will lead the committee. “If we have more information on what’s going on in different states, then we can try to do something about it.”

McMahon’s complaints with the Medicaid program in Wyoming, where she’s president and CEO of Frontier Access & Mobility, include a cost-plus-15% pricing methodology for non-coded items.

“Maybe a car dealership can run on cost plus 15%, but I can’t,” she said.

At the very least, collecting information on Medicaid reimbursement rates and policies in different states will allow complex rehab providers to vent, Margolis said.

“It’s almost like a 12-step program for Medicaid,” he said.