In West Virginia, incontinence supplies become sparse
CHARLESTON, West Va. - West Virginia providers who offer incontinence supplies have seen that business line plummet by 30% to 70% thanks to new state rules that limit coverage.
"(Medicaid) has essentially cut out coverage for incontinence supplies," said Kelley Matusic, owner of My Family Medical in Hurricane, West Va., which has seen roughly a 50% drop in its incontinence business. "It seems like they'll approve meds, catheters and even surgery for incontinence before they'll approve disposable diapers."
Providers across the state report it's harder to get incontinence supplies approved now that West Virginia Medicaid requires prior authorization. Also, the state no longer covers diagnoses that it used to cover, such as stress-induced incontinence. The changes took effect summer 2005.
The state implemented the rules largely to cut back on fraud and abuse, said Richard Stevens, who heads up the West Virginia Medical Equipment Suppliers Association (WVMESA).
"Someone in the governor's office said to me, 'For God's sake, Richard, they're selling diapers that have been purchased by Medicaid on the road sides and at flea markets," he said.
Matusic said she's heard of some providers fraudulently replenishing a beneficiary's supply of supplies without calling him to find out whether he needed them or not. (Her company's policy is to call first.) "That's why there's an overflow," she said.
But eliminating fraud and abuse isn't the only reason why there are fewer supplies being dispensed. Some physicians have also washed their hands of the supplies due to the amount and complexity of the paperwork involved, Stevens said.
At the end of the day, some beneficiaries who need incontinence supplies aren't getting them--or at least not without paying a price, Matusic said. "They're paying for them out of pocket," she said. "A case of 72 briefs is going to cost you $35; a case of pull-ups $59. And that might last you a week."
Christopher Sizemore, vice president of Loop Pharmacy and Home Medical in Saint Albans, West Va., which has also seen at least a 50% drop in its incontinence business, agreed that some beneficiaries who need supplies aren't getting them.
"People don't wear (disposable diapers) because they're stylish," he said. "What does (Medicaid) expect these people to do?"