OAMES fights oxygen reimbursement cut
COLUMBUS, Ohio - The Ohio Association of Medical Equipment Services continues efforts to drive back the state's plan to not only cut reimbursement for respiratory equipment by more than 50% but also to make it a capped rental item.
Ohio's Medicaid program has proposed a rule that would drop reimbursement for oxygen concentrators to about $75 a month, with a maximum payout of $750 for 10 months. Right now, reimbursement stands at about $178 a month, with no cap, said Kamela Yuricich, executive director of OAMES.
"[The rule] is very precedent setting," she said. "We can't support it based on the clinical nature of these items. Oxygen is a therapy benefit in the home, not just a piece of equipment."
The state's plan was supposed to kick in Sept. 1, 2005, but it has been delayed twice--first to Jan. 1, 2006, and now to April 1, 2006. OAMES expected a new draft of the rule in mid-November.
A big reason for the delay is lobbying by OAMES and respiratory therapy associations. The groups finally hit a nerve with the state srecently, when they began lobbying the body of legislators who oversee rule development for the state, Yuricich said.
"We were able to communicate and educate to the legislators how difficult and unreasonable this change would be," she said. "They then reached out to the state and said, 'You really need to sit down with the industry and work through this.'"
Yuricich said she has few details of what the revised rule will look like, other than that it will be "constructed in a way that separates long-term care and home care oxygen." But she's heard the state is making "major changes."
If the rule stands, as is, it would have a huge impact on providers like Ary Van Harlingen, president of Shaw & Ott Medical Supplies in Mansfield, Ohio. Respiratory makes up about 40% of the full-line DME's business mix,he said.
"It's a little hard to put respiratory therapists out there and do follow-ups and maintain equipment when that's what you're getting in return," Van Harlingen said of the $75 reimbursement and $750 maximum payout.