National Medicaid Summit: Attendees discuss common issues, develop common strategies

Thursday, October 14, 2010

NASHVILLE - It turns out that if you build an event for complex rehab providers to learn about Medicaid issues, they will come.

 "It was one of those things where, we thought there was a need, but we weren't sure," said Don Clayback, executive director of NCART, which hosted the first National Medicaid Summit here Oct. 6 and 7. "It went really well." Ninety-five attendees participated in the Summit's 14 educational sessions, which included a legal review and a provider panel. Here's what Clayback told HME News about what attendees took away from this year's Summit and the plans for next year's event.

HME News: The complex rehab industry has wanted to take on Medicaid issues on a broader scale for some time, but it has struggled because every state's program is different.

Don Clayback: Every state does have differences, but there are a lot of commonalities. All states are undergoing financial difficulty, so all providers are looking at cutbacks. There are also some basic regulations that all states need to follow if they're going to participate in Medicaid. One of the benefits of coming together was focusing on some of those common issues and developing some common strategies.

HME: What are some of the basic regulations that all states need to follow?

Clayback: If a state is contracting with a manage care payer for Medicaid beneficiaries, for example, the payer can't limit or make the coverage more restrictive than what a traditional Medicaid beneficiary would receive. The payer can't make different policy. Another example: Some states don't cover certain adaptive equipment even though there are broader regulations that say, if the equipment is medically necessary, it can't be casually eliminated as something not covered.

HME: What should providers do when these regulations are violated?

Clayback: You have to get your state's definition for DME and determine if there's anything that identifies the item you're trying to get covered as not covered and then, ideally, you have someone with an advocacy or legal perspective take a look at it. There are no silver bullets, but based on the feedback we got, attendees felt more informed and felt like they had new ideas and tools to deal with state issues.

HME: So the Summit went well enough that there's going to be a second event?

Clayback: We're already making plans to make that happen.

HME: What will you do differently?

Clayback: The attorneys were there to give overviews and we'd like to take that to the next step. If states aren't following the rules, what are some examples of what, specifically, should be done. We were able to talk to some extent about that, but time didn't allow us to really drill down. Maybe we also bring in representatives from some of the state Medicaid programs to get their perspective.