Stakeholders home in on Medicaid strategy

‘The states are going to get less money and the big question now is, how are they going to deal with that?’
 - 
Friday, January 20, 2017

WASHINTON – A directive from Congress to tie Medicaid reimbursement to Medicare reimbursement will be a tough pill to swallow for not only HME providers but also states, industry stakeholders say.

A “pay for” in the 21st Century Cures Act stipulates that the federal government’s share of Medicaid reimbursement to states for DME be limited to Medicare payment rates, rates that have been decimated by subsequent rounds of competitive bidding.

“The states and the DME providers are in the same boat,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “The states are going to get less money and the big question now is, how are they going to deal with that?”

The change in Medicaid reimbursement is slated for Jan. 1, 2018.

AAHomecare convened a sub-group of its Regulatory Council recently to strategize how to best handle the change in Medicaid reimbursement. What the 15 members came away realizing: There are a lot of questions that need to be answered.

“Like a lot of laws, it gets passed and then everyone goes, ‘How does it actually get implemented’?” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “What are the states actually required to do?”

It’s Brummett’s initial sense that the money the states get from the federal government for Medicaid isn’t tied to the Medicare fee schedule per se, but to a formula. So the big question isn’t, do they have to match the bid rates, but, how does that formula change, she says.

Members of the sub-group are in the throes of doing research on this and other details, so they can then approach state Medicaid programs with “really good information,” Brummett said.

“We want to be able to go to them and say, ‘This is a law, here is a legal opinion (on how to implement it),’” she said. “As opposed to them going, ‘We have to meet those competitive bidding fee schedules.’”
The earlier stakeholders start having conversations with state Medicaid programs, the better, Bachenheimer says.

“Getting in with state officials to talk through this is key, so that maybe we can figure out ways to make whole the payment amount in some way,” she said. “States don’t have a pot of gold to pour into it, so it’s not going to be easy.”