New England: Provider outreach pays off

Massachussetts backs off plan to bypass HME providers; Rhode Island moves forward with cut
Friday, September 25, 2015

BOSTON – MassHealth has given stakeholders its word that the agency will not pursue volume purchasing for HME like incontinence products.

The state in May included language to allow the state’s Medicaid program to contract directly with DME manufacturers and distributors, bypassing providers, in its proposed Medicaid budget for fiscal year 2016.

Although the governor in July signed the budget into law, MassHealth is not required to contract with DME vendors.

“We met with the department head of Medicaid and they told us that they’re not going to move forward with that,” said Karyn Estrella, president and CEO of Home Medical Equipment and Services Association of New England.

Provider Peter Tallas credits MassHealth’s decision not to leverage the language to stakeholder outreach. 

“I’d like to think that the conversations we had (with MassHealth) about the services we provide and our relationships with our customers had some bearing on that decision,” said Tallas, president and CEO of Pembroke, Mass.-based Charm Medical Supply. 

When the budget was first proposed, providers were quick to point out the additional costs associated with storage and delivery, as well as the service needs of patients. 

Unfortunately, stakeholders in Rhode Island didn’t have as much luck. They failed to convince Medicaid officials to hold off on its decision to reduce reimbursement rates by 50% for incontinence products. 

“I know that some of our members did submit comments, but based on the Office of Inspector General’s report on all 50 states, Rhode Island is just bringing (the reimbursement rate) in line with an industry standard,” said Estrella.

Last year, an OIG study found that Rhode Island had one of the highest reimbursements for incontinence products.