Pay-for causes concern

Tuesday, December 22, 2015

WASHINGTON – A provision that would limit the federal portion of Medicaid allowables to match the new payment amounts in a given area starting in 2020 raises concerns, but stakeholders say it’s worth the risk. 

The provision was included in a bill in the Senate as a pay-for for other provisions that would increase payment amounts in rural areas by 30% and in regional areas by 20%, and phase in the changes over two years.

“It’s not ideal, but there must be a pay-for and is the only option that we have,” said Karyn Estrella, president and CEO of Home Medical Equipment and Services Association of New England.

Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., introduced the bill, S. 2313, on Nov. 19 (see story page 1). 

The trouble with analyzing the impact of the provision is, stakeholders have no way of knowing what payments will be in 2020. 

The legislation would require CMS to revisit pricing adjustments for non-bid areas, taking into account travel distance, clearing price and other associated costs for prices in effect Jan. 1, 2019.

“The rates will be re-evaluated in 2019,” said Estrella. “Whatever happens in 2020 will not be based on the rates that are currently in existence. That’s what makes it even more complicated.”

Still, stakeholders are optimistic that they will be able to reverse the provision before it kicks in.

“With the pay-for not going into effect until 2020, this gives the industry time to push back and work with our members of Congress and state Medicaids to prevent that from happening,” said Estrella.