Taking Stock: 2018 Medicaid Advocacy Effort Pays Off

AAHomecare says a year-long effort to work with state Medicaid programs helped stop or curtail CURES cuts in 29 states.

A year-long effort undertaken by Laura Williard, vice president of payer relations for the American Association for Homecare, as well as state and regional HME associations to alert and educate state Medicaid officials that they had flexibility in implementing provisions of the CURES Act has protected HME funding in 29 states, according to AAHomecare.

Passed in December 2016, the CURES Act includes provisions to give relief to providers and patients affected by the national expansion of competitive bidding to non-bid areas. However, the Act also accelerated a plan to limit the federal financial participation (FFP) matching funds on Medicaid reimbursement for HME so that the state reimbursement couldn’t exceed 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.

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

  • They 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, state programs 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.”

However, many state programs were unaware of their options. So Williard worked with state and regional HME association leaders to educate officials from state Medicaid programs regarding their alternatives. Williard worked with state programs to compare their Medicaid spend versus Medicare spend on codes covered by CURES to thoroughly understand how each option impacts their budget, according to a statement from AAHomcare.

“… Without going through this exercise, many states would have simply adopted the Medicare fee schedule,” the statement noted.

AAHomecare participated in meetings with Medicaid officials in 28 states and provided materials and guidance in 42 states. Of the 36 states that were not at or below Medicare rates, 29 of them were influenced positively through the effort:

  • Eighteen states chose not to reduce 2018 rates. They  were Alaska, Florida, Georgia, Hawaii, Indiana, Iowa, Massachusetts, Michigan, Minnesota, North Carolina, Oklahoma, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota and Texas.
  • Seven states limited the scope of cuts or agreed to phase them in over a longer period.
  • Four others continue to analyze their data.

Further details on each state can be found on AAHomecare’s CURES implementation scorecard.

AAHomecare says it will work with the 29 states to keep rates stable and will work to meet with state Medicaid programs that chose to match Medicare’s fee schedule. It also plans to develop resources for state and regional HME associations to use when engaging with legislators and regulators.


About the Author

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



Fri, Jan 11, 2019 Scott Dannenberg Raleigh NC

Does this mean that, as in NC, if Medicaid left the fee schedule as is for 2018, they are allowed to retroactively adjust these paid 2018 claims if Medicaid adjusts the fee schedule in 2019?

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