Advocates Keep Working to Contain CURES Medicaid Cuts

Various stakeholders continue coordinating with state Medicaid programs to ensure they maintain sustainable funding.

The fight to contain the CURES Act’s impact on Medicaid funding for HME continues. Industry advocates from the American Association for Homecare, the National Coalition for Assistive and Rehab Technology, state and regional HME associations, and VGM Government Relations, as well as other industry stakeholders, continue meeting with state Medicaid programs to limit the impact of the Act at the state level.

Passed in December of 2016, the CURES Act included provisions to give relief to providers and patients affected by the national expansion of competitive bidding to non-bid areas. However, the Act also included an acceleration of the plan to limit the federal financial participation (FFP) matching funds on Medicaid reimbursement for HME to the Medicare fee-for-service payment rates, including for items impacted by competitive bidding-derived rates. Rather than apply those rates in January 2019, the application was to be ramped up by one year to Jan. 1, 2018.

States Medicaid programs have a couple of option as to how they approach this:

  • State programs can change their Medicaid state plan DME payment methodology to pay at or a lesser percentage of the Medicare rates for applicable DME items or by amending their state-developed fee schedules.
  • Alternatively, they can opt for an aggregate payment comparison or an alternative approach to compliance. CMS has said it will work with those programs to “determine the best approach to calculate the FFP limit for their state using expenditures for the period of Jan. 1, 2018 through Dec. 31, 2018.”

The change impacts funding for a subset of 244 DME HCPCS codes

AAHomecare reports that it has met with 21 total state Medicaid programs since December 2017 to educate and partner with them to help them comply with the legislation while maintaining sustainable reimbursement and patient access for HME/DME services.

As of May 2, 11 states have indicated they will change their fee schedules to Medicare rates: Vermont, Montana, Washington, Colorado, Iowa, Kentucky, North Dakota, Connecticut, Maine, Massachusetts, and Alabama. AAHomecare noted that it is working with state associations to convince Iowa, Kentucky, Connecticut, and Alabama to reverse their decision or limit it to a smaller amount of HCPCS based on their utilization.

Twelve states have indicated that they won’t change rates at this time: Florida, Georgia, Hawaii, Michigan, Minnesota, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Indiana.

Ten states are still analyzing their data with CMS and AAHomecare to develop their response: New Hampshire, Illinois, New York, Kansas, Missouri, Oklahoma, Rhode Island, Wisconsin, Nebraska, and South Dakota. 

“It’s gratifying to work alongside so many dedicated individuals across the country to encourage state Medicaid officials to take a careful look at their options for complying with the CURES Medicaid provisions,” noted Laura Williard, vice president of payer relations for AAHomecare in a public statement. “The persistence and a team-approach exhibited by these leaders has made all the difference in our successes thus far. The state Medicaid programs have been open to meeting with AAHomecare and stakeholders and are appreciative of the partnership to comply with CURES.”


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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