Oregon DMEs fight Medicaid cut

SALEM, Ore. - The Office of Medical Assistance Programs (OMAP) in Oregon, which oversees the Medicaid program, slashed fee-for-service reimbursement rates for DMEPOS on Oct. 1 from 100% of the 1999 Medicare maximum to 80% of the 2002 Medicare maximum. All this to save $300,000 in the state's general funds as part of efforts to ease a budget shortfall, it says. According to the Pacific Association for Medical Equipment Services (PAMES), which represents HME and DME providers in Oregon and Washington, something doesn't wash in that equation. With 735 DMEPOS providers enrolled in the state, including pharmacies that bill for DMEPOS, the cost to providers will far exceed a few hundred thousand dollars. The cuts were part of a bill titled HB-5091, which included other program reductions for the state's Department of Human Services as well. Since the passage of the bill, several DMEs in Oregon have banded together through PAMES to hire a lobbyist, Richard Kosesan, who is working with state Sen. Lenn Hannon (R-Ashland) and the legislature's Emergency Board to rescind the reduction. “Our Medicaid Committee has questioned the state on their formula used for figuring out the cut and resulting savings,” said Jennifer Jones of OMAP. “This is one of the issues that Richard and Sen. Hannon are bringing up with the state.” “Sen. Hannon seems to have taken up the torch for us, and he's a very strong person in Salem, a longtime legislator,” said Andy Boesl, who chairs the Oregon Medicaid Committee of PAMES and is regional marketing director for Medford, Ore.-based Home Medical. “We are confident we can get this decision turned around very soon.” One potential fly in the ointment is a claim by OMAP that providers in the state were involved in the decision-making process earlier in the year. “It appears the agency wants, through inference, to suggest that the provider community has previously accepted the reduced reimbursement rates,” Boesl said. “PAMES is aggressively tackling this stance as no public hearing or study was done to our knowledge that shows the impact to the disabled, elderly and fragile populations of Oregon from this change.” Regardless of whether PAMES secures a total reversal or some lesser outcome, Boesl is heartened by the way DMEs have rallied to the cause. “At my company and at others, we have decided that we can no longer just be reactive; we need to be proactive,” he explained. “We have to either be developing legislative options ourselves or racing to respond to legislation from Salem. There are costs either way. “What we've seen with this situation is that with several of us DMEs pitching in a mere $500 each, we were able to hire a lobbyist and get something done. I worked for a year to get an audience with my local representative without success. Once we had a plan and a person representing us at the statehouse, we got a response back in 45 minutes.” HME