President Obama’s 2015 budget, released earlier this week, includes a number of DME-related proposals, including applying competitive bidding payments to Medicaid reimbursement.
To download the budget as a PDF, visit:
http://www.whitehouse.gov/sites/default/files/omb/budget/fy2015/assets/budget.pd
The President’s 2015 budget aims to enhance efforts to cut “waste, fraud, and abuse” in Medicare and Medicaid in order to save nearly $1.1 billion over the next 10 years. As part of that agenda, the budget proposes having Medicaid reimbursement mirror Medicare reimbursement rates.
“States have experienced challenges in preventing overpayments for durable medical equipment (DME),” the budget reads. “Starting in 2015, the Budget would limit Federal reimbursement for a State’s Medicaid spending on certain DME services to what Medicare would have paid in the same State for the same services.”
In addition to applying Medicare rates to Medicaid reimbursement, the President’s 2015 also proposes to:
- Implement new initiatives to reduce improper payments in Medicare.
- Require prior authorization for power mobility devices and advanced imaging.
- Possibly expand that prior authorization to “other items and services at high risk of fraud and abuse.”
The power mobility portion of the industry has been working through the prior authorization demonstration project since September 2012. While the project has been relatively straightforward, the language in the President’s budget was less so.
“AAHomecare is working with CMS to make necessary changes [to the demonstration project], and continues to advocate for improvements,” a public statement from AAHomecare read. “However, the budget proposal is very vague, so it’s unclear how it would be implemented.”