NCART to Medicaid: New fee schedule 'absolute pricing floor'

Sunday, December 24, 2006

WASHINGTON - NCART launched a campaign last week to educate state Medicaid directors on the danger of further reducing Medicare's new fee schedule for power mobility devices.

It's not unusual for Medicaid programs to pay only a percentage of what Medicare pays. If that becomes the case here, however, access to appropriate technology will be threatened, sources said.

"The Medicare fee schedule is really the rock bottom of what providers of complex rehab and technology can deal with," said Sharon Hildebrandt, NCART's executive director.

Medicare's new fee schedule, which went into effect Nov. 15, already represents 10% to 30% cuts, depending on the PMD.

NCART sent letters to Medicaid directors in each state, carbon copying their governors. Copies of an NCART report called "Adopting Medicare Power Mobility Policies Will Impact the Provision of Appropriate Client Services" accompanied the letters.

In the report, NCART recommends that Medicaid programs use the Medicare fee schedule as the "absolute pricing floor."

"Moreover, consideration should be given to increasing reimbursement above the Medicare fee schedule should your state be primarily rural in nature or other special circumstances exist, such as additional processing requirements," the letter reads.

The letters and the report are an important part of dispelling the myth that all PMD providers enjoy high profit margins, Hildebrandt said. For clients with significant disabilities, providers may spend 97 cents on every $1 on equipment alone, according to NCART.

"The new pricing we got out of CMS is acceptable but marginal," said Simon Margolis, an NCART executive member. "But if Medicaid takes more off of that, the pricing will be unacceptable."

After sending out the letters, NCART planned to work with various state associations to follow up with Medicaid directors.