Providers get incontinence boost

Monday, June 30, 2008

CHARLESTON, West Va.--Two years after West Virginia Medicaid made it tougher to furnish incontinence supplies, some home healthcare agencies are throwing in the towel, giving providers a boost.

Several providers reported in May that they’ve received an increasing number of referrals from HHAs for the supplies.

“We’ve had a slew of referrals this month,” said Kelley Matusic, owner of My Family Medical in Hurricane, which relies on incontinence supplies for 10% to 15% of its business. “It seems like HHAs are getting out of the business.”

In 2005, Medicaid began requiring prior authorizations for incontinence supplies, making it more difficult to get approvals for a product category already considered a challenge due to low reimbursement. The agency also eliminated coverage for certain diagnoses.

Unlike HHAs, providers have been able to make do by negotiating better pricing with manufacturers, they say.

“We’ve put together a better program, so our incontinence business hasn’t dropped at all,” said Christopher Sizemore, vice president of Loop Pharmacy and Home Medical in Saint Albans.

Loop Pharmacy receives two or three referrals per month from HHAs, he said.

The West Virginia Medical Equipment Suppliers Association has been talking to Medicaid officials about expanding coverage for incontinence supplies, said Executive Director Richard Stevens.

“In many instances, the current coverage isn’t satisfying the needs of patients,” he said.