Rhode Island: Medicaid tries to go retro on rates

Friday, May 24, 2013

PROVIDENCE, R.I. – State officials have delayed a rate cut to the Medicaid program in response to concerns from HME providers. 

On April 19, Medicaid officials announced new rates based on the Medicare fee schedule minus 15%. The state planned to implement the cuts retroactive to July 1, 2012, over a period of five payment cycles, starting May 10.

Needless to say, this didn’t go over well with providers.

“How can they call it a new rate and go backward?” asked one provider who didn’t want to be named. “Is that legal?”

It may not be. Last July, the state sent out contracts to providers with rates that now differed from the rates announced in April.

“You have the companies that did sign those contracts last year and nine months later learn that the state is going to take all this money back,” said Karyn Estrella, executive director of the New England Medical Equipment Dealers.

There’s also some confusion about whether the new rates affect every product category because there is no fee schedule for certain items, like incontinence supplies.

“I am assuming they are including incontinence,” said the provider. “No one has been able to answer that question for me.”

NEMED in May planned to meet with state officials to discuss the change.