GAMES, AAHomecare Stop Ga. Medicaid Cuts

Rapid response by associations stops Georgia DCH from basing Medicaid rates on the Medicare fee schedule.

The Georgia Association for Medical Equipment Suppliers (GAMES) with help from the American Association for Homecare recently succeeding in convincing the Georgia Department of Community Health (DCH) to avoid making tough cuts to Medicaid reimbursement for DME items.

Per the CURES Act, implementation of the plan to limit the Federal matching on Medicaid reimbursement rates for HME to the Medicare fee-for-service payment rates — including for items impacted by competitive bidding-derived rates — was pushed up from January 2019, to Jan. 1, 2018.

In late December, CMS told state Medicaid programs they had two main options for resolving this:

  • Base Medicaid DME reimbursement rates on Medicare’s fee schedule or competitive bid rates.
  • Use both rate and unit utilization data to determine what would be the aggregate reimbursement under Medicare for those same items in order to demonstrate that the state payments are less than the allowable amount.

Georgia DCH initially opted to base its Medicaid rates on the Medicare fee schedule after estimating that using the aggregate reimbursement method would result in a $10 million shortfall.

GAMES responded by providing DCH with analysis based on updated CMS guidance that showed the state’s Medicaid program was actually under the aggregate model without incurring any fee schedule changes, according to a report from AAHomecare.

As a result, Georgia Medicaid chief Blake Fulenwider agreed and informed GAMES that patients and providers in the state would not be hit by the cuts that would have come with the simple option of adopting Medicare rates.  

AAHomecare’s Laura Williard, AAHomecare’s vice president for payer relations and a GAMES boardmember, helped the Georgia team craft their arguments and was part of meetings with Georgia DCH. AAHomecare that it worked quickly to clarify which HCPCS codes were impacted by the CURES provisions as part of the effort.

The team approach worked well

“We appreciate DCH’s willingness to keep an open mind and work towards a solution that benefits both patients and Georgia taxpayers,” said GAMES President Tyler Riddle, also the vice president of MRS Homecare.  

“We’re fortunate to have a partner at the state level who understands the importance of maintaining a viable HME infrastructure to provide cost-effective care that can help keep seniors and people with disabilities in their homes,” said GAMES president-elect Charlie Barnes IV, CEO of Barnes Healthcare Services.

That close relationship was long in the making, according to GAMES executive director Teresa Tatum.

“We’re fortunate that we started working with Blake Fulenwider almost a decade ago when he was part of Rep. Nathan Deal’s staff in D.C., with HME providers from Georgia engaging him on competitive bidding and other issues at AAHomecare’s annual legislative conferences,” Tatum said. “It’s a great reminder that the work you put in building credibility with legislators and regulators over time can return important dividends in the long run.  If we have more providers getting involved in advocacy efforts through their state associations and AAHomecare, I believe we’ll get even better public policy outcomes for our entire industry.

About the Author

David Kopf is the Executive Editor of HME Business and DME Pharmacy magazine. Follow him on Twitter at @postacutenews.



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