CMS Will Factor in IFR for CURES Medicaid Rates

AAHomecare convinces CMS to permit state Medicaid programs to use the higher rates for claims that are impacted by the CURES mandates until Dec. 31.

After CMS’s release of the IFR, the American Association for Homecare has met with the agency to discuss how the recently released IFR’s rates should be factored into the 21st Century Cures Act’s Medicaid mandate.

Passed in December 2016, the Cures Act gave relief to Medicare 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.

States Medicaid programs have a couple of option for 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 federal financial participation (FFP) limit for their state using expenditures for the period of Jan. 1, 2018 through Dec. 31, 2018.”

The IFR resumes the 50/50 blended rate schedule starting for claims filed June 1 through Dec. 31 and will affect rural areas and non-contiguous areas (Alaska, Hawaii and U.S. territories) that are non-bid areas .

CMS had indicated that any changes to the fee schedule would not impact Cures reconciliation as it would use the Jan. 1, 2018 fee schedule. However, AAHomecare then met with CMS and presented information on the new fee schedules for rural areas.  After reviewing that information, CMS agreed that states Medicaid programs that are processing claims based on competitive bid area, non-rural, and rural areas could use the higher rates for claims filed between June 1 and Dec. 31, 2018.  

CMS also agreed that state Medicaid programs that are not basing their rates on Medicare rates can present their usage data for reconciliation based on area-of-service and for claims dated from Jan. 1 through May 31, 2018, and June 1 through Dec. 31, 2018.  CMS will then use the higher rates for the rural areas in the reconciliation process.  

“I am happy we were able to influence CMS to utilize the rates that offered relief to many rural areas,” said Laura Williard, vice president of payer relations for AAHomecare,

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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