Medicaid targets concentrator cuts

Wednesday, April 30, 2008

COLUMBUS, Ohio - Ohio Medicaid won't let it go.
For three years now, the program has targeted oxygen concentrators, currently reimbursed at about $178 per month, for cuts. In 2005, it proposed reducing reimbursement to $75 per month with a maximum payout of $750 for 10 months. In 2006, after pushback from the industry, it proposed reducing reimbursement to $100 per month with no maximum payout.
In its latest proposal, Medicaid proposes reducing reimbursement to $81 per month for concentrators used in the home and $75 per month for those used in long-term care facilities with no maximum payout. Its target implementation date: July 1.
"Simply stated, that payment level isn't realistic or viable," said Johnny Miller, homecare manager for Miller's in Akron, Ohio. "If this goes through, we wouldn't be able to provide oxygen to Medicaid beneficiaries; we'd work to transition them to other providers."
In March, Medicaid received 123 comments from providers like Miller. Its next step: hold a public hearing.
Medicaid came up with $81 and $75 per month after auditing two providers that provide oxygen concentrators to nursing facilities. The program found the providers charged, on average, about $48 and $58 per month for concentrators.
Because Medicaid audited only providers who provide concentrators to nursing facilities, providers argue, it's comparing apples to oranges.
"If you get maintenance calls for a nursing facility, you make one trip," said Jackie Montville, who manages accounts receivable and government reimbursement for Medical Services Co. in Cleveland. "You're not driving all around the area."
Numerous providers commented to Medicaid that, at $81 per month, they would no longer be able to provide the same services and repairs-if they could provide concentrators at all. The program responded that providers should consider themselves lucky: Minnesota Medicaid pays, on average, about $38 per month for concentrators.
"Minnesota Medicaid data tell us, and conversations with their staff confirm, that providers will continue to provide access to oxygen concentrator services in the private residence while maintaining acceptable standards of care at a payment rate far less than anything Ohio is proposing," Ohio Medicaid stated. HME