New York, Alabama Sleep Providers Score Medicaid Wins

New York Medicaid unbundles CPAP and BiPAP payments. Alabama Medicaid updates PAP device policies. Both moves should mean reimbursement gains for providers in those states.

Sleep providers in both New York and Alabama notched key policy wins with their respective state Medicaid programs that should help them contend with increases in their cost structures.

New York

The New York State Medicaid program moved to unbundle CPAP and BiPAP supplies, effective June 1. This should mean larger reimbursement for various sleep therapy items, ranging from core PAP therapy devices to masks to tubes.

The move came after advocates from the Northeast Medical Equipment Providers Association (NEMEP) and the American Association for Homecare impressed upon the Medicaid program that cost increases related to the severely attenuated supply chain of sleep therapy equipment were increasing their costs to provide supplies to sleep therapy patients. That problem was further exacerbated by Medicaid Managed Care Plans reimbursing less or not at all for some bundled sleep items.

Beth Bowen, Executive Director of NEMEP, thanked her members:

“Because of your membership and support, NEMEP’s strength pays off,” she noted in a public statement relayed by VGM Government Relations. “Your NEMEP Medicaid committee continues to work hard on relationships with the N.Y. and N.J. Medicaid departments. Last month NEMEP scored a BIG win for New York! CPAP payments are now unbundled.”

Alabama

In Alabama, the state Medicaid program will now bill CPAP and BiPAP devices as a “straight purchase,” ending the rental period payment process for the equipment. The agency also announced the waiver of the compliance requirement for CPAP and BIPAP devices, and updated allowable quantities for PAP supplies. The new measures go into effect on Aug. 1.

The news comes after David Chandler, senior director of payer relations with the American Association for Homecare, joined with leaders from the Alabama Durable Medical Equipment Association (ADMEA), as well as the Alabama Chapter of the American Academy of Pediatrics, to advocate for those policy changes in an early June meeting with Alabama Medicaid officials. Similar to the issues facing New York sleep providers, the group provided insights on how the ongoing supply chain issues for PAP devices were affecting patient access, particularly for equipment with remote monitoring capabilities.

“We appreciate the Alabama Medicaid Agency’s collaborative approach to developing policies that allow HME providers to more effectively serve their beneficiaries,” said ADMEA chair Leigh Ann Matthews. “Kelli Littlejohn Newman, director of clinical services and support for the agency, has been instrumental in developing a partnership approach with our industry. The ADMEA Medicaid DME Advisory Committee’s quarterly meetings with Alabama Medicaid have ensured a strong line of communications between the Agency and HME stakeholders.”

“ADMEA has done an exceptional job establishing credibility with Alabama Medicaid leaders and pediatric patient stakeholders,” noted Chandler. “Their efforts paved the way for very productive — and ultimately successful — discussions with the agency.”

 

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