Thursday, March 25, 2010

COLUMBUS, Ohio - A change in the way the state's Medicaid program pays for long-term oxygen and complex rehab services for beneficiaries in nursing facilities has left HME providers in the lurch.

Medicaid used to reimburse providers directly for the services they provide to beneficiaries in nursing facilities. Now it bundles the reimbursement for providers with the reimbursement for nursing facilities.

The problem: Providers are having a hard time getting reimbursed from nursing facilities or they're not getting as many requests for service from the nursing facilities anymore.

"Our requests for service have dried up to almost nothing," said Johnny Miller, vice president of home care for Miller's Rentals & Sales in Akron, Ohio. "They just went away overnight."

Now providers are scrambling to replace that lost revenue with other business, or if that fails, laying off staff.

The word on the street is that nursing facilities, which are also struggling, are trying to hold on to the extra reimbursement they're now getting for oxygen and complex rehab services by, for example, recycling equipment.

"They're finding ways to work around it," said Dan Craig, vice president of rehab mobility at Miller's. "The money wasn't earmarked so they figure they can use it to make themselves whole again."

Providers aren't the only ones that have noticed the change. Beneficiaries have, too. An ombudsman group in the state has collected 28 complaints since the change went into effect last year.

With help from the Ohio Association of Medical Equipment Services (OAMES) and Invacare, providers are trying to get the change reversed in an upcoming corrections bill for the state budget.