Pennsylvania proposes power wheelchair cuts

Wednesday, October 31, 2007

HARRISBURG, Pa. - Providers were shocked on Sept. 24 when Medicaid announced it would pay only 80% of the Medicare allowable for power mobility devices, effective immediately.
For a scooter, that means where Medicare reimburses $1,292, Medicaid now reimburses $1,034. It used to reimburse $1,695, according to John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers (PAMS).
"That's a 37% cut," he said. "The new reimbursement rates are such that there may be a mass exodus from the Medicaid program."
It's not uncommon for states to pay only 80% of the Medicare allowable. In Pennsylvania, Medicaid already uses the formula for other HME. For PMDs, however, Medicare has already cut allowables, on average, by 27%, compounding Medicaid's cuts.
PAMS planned to crosswalk the old Medicaid allowables with the new allowables for hundreds of PMD codes "to show Medicaid just how much of a decrease it is for each item," Shirvinsky said.
The association also planned to educate consumers on the reimbursement changes and the likely impact on access.
Ultimately, PAMS hopes it can "go back to the table," said Georgie Blackburn, past president of the association.
"They didn't go to us or use us for any educational information about why we could or couldn't provide power wheelchairs at this level," she said. "It's not that we should call all the shots, but they should at least take into account the impact on providers."
Medicaid adjusted pricing as part of adopting Medicare's new codes for PMDs.