Kentucky Providers Urged to Support State DME Bill

KMESA is calling on HME businesses and stakeholders to lobby state lawmakers on behalf of legislation that would streamline DME requirements.

The Kentucky Medical Equipment Suppliers Association (KMESA) is calling on providers and stakeholders in the Bluegrass state to quickly act in support of H.B. 224, a state bill that would protect and streaming funding for HME.

The bill contains several provisions, according to the association:

  • It ensures that HME providers are paid at the rate set by the Kentucky Medicaid program.
  • When the managed care organization (MCO) issues coverage “prior authorization,” claims cannot be denied for lack of medical necessity.
  • When patients transfer from one MCO to another, the services currently being rendered by the originating MCO under a prior authorization must be honored for the amount, duration and scope until the prior authorization period ends.
  • Many miscellaneous items (such as parts to customize wheelchairs) are not listed on a fee schedule.  The bill would require that these
  • All specialty and miscellaneous parts shall be reimbursed at the manufacturer’s suggested retail price minus 15 percent or at invoice cost plus 20 percent when this is no MSRP.
  • At the minimum, MCOs must cover the same quantities of supplies established in the Kentucky Medicaid program DME schedule.
  • HME providers must receive the same time frame for appeals and re-billings as the MCOs receive for claim denial and audits.
  • HME providers are no longer required to purchase Medical Necessity guidelines so that they can know the rules and ensure their services adhere to them.

KMESA and AAHomecare called on providers in Kentucky to take action and lobby their state lawmakers now, given that the Kentucky legislative session is short.

“This is a short session and the clock is not our friend,” an alert from KMESA read. “The calls need to come in volume and soon. Any warm body that will pick up the phone needs to. The administration has concerns about the costs of increased reimbursements and the MCOs are going to put up a tough fight. … Please have your employees and customers make contact with their representatives … .”

The bill has been assigned to the House Health & Family Services Committee, and KMESA urged providers to contact the members of that committee as soon as possible either via email or by calling the main State House switchboard at (502) 564-8100 and asking to be connected to the appropriate office. The key lawmakers are:

To help providers lobby on behalf of the bill KMESA and AAHomecare have provided a collection of H.B. 224 Talking Points for Patients and Families, as well as DME Bill talking points fil. Also, providers with additional questions are encouraged to email  Teresa Aldridge, executive director of KMESA.

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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