Indiana Halts Oct. 1 HME Cuts

Hard-fought lobbying effort from Great Lakes Home Medical Services Association and other advocates eventually convinces state Medicaid program to stop implementing of proposed cuts until further review and analysis.

An intensive advocacy push by Indiana HME providers and industry groups earned a hard-won reprieve from state Medicaid reimbursement cuts that would have impacted a staggering array of HME items starting Oct. 1.

On Sept. 3, Indiana’s Family and Social Services Administration (FSSA) announced its plan to reduce reimbursement rates to match the lowest Medicare allowable for more than 2,000 HCPCS codes.

Given the peril this plan posed for patient access, the Great Lakes Home Medical Services Association (Great Lakes), the American Association for Homecare, the VGM Group, the National Coalition for Assistive and Rehab Technology (NCART) and other industry stakeholders joined efforts to convince FSSA to indefinitely press pause on the cuts until further analyzing them. The advocates’ efforts to fend off FSSA’s cuts included:

  • Requesting the CMS regional office to delay approving the state’s Medicaid plan amendments pending further analysis.
  • Meeting with FSSA provider relations staff.
  • Mobilizing Indiana HME providers and referral sources to engage state legislators to reach out to FSSA to ask for a delay.
  • Exploring a public relations campaign with Indiana media outlets.
  • Researching a potential legal challenge and call for a temporary restraining order to delay cuts.
  • Sharing information and meeting with the FSSA director and assistant director.

That outreach included meeting with FSSA leaders to show how its cuts far exceeded 2016 CURES Act requirements; explaining how those cuts would hurt patients; and offering to analyze how the state could comply with the CURES Act without cutting too much (a strategy AAHomecare noted in a public statement had worked for it in 20 other states). Great Lakes and the other advocates were also poised to inform the news media of the potential impact of the cuts.

By Sept. 27, Indiana FSSA informed Great Lakes Executive Director Kam Yuricich that it would hold off on the cuts until it could further review and analyze their impact.

“This was a full team effort from the day the announcement was made to last Friday when I received the positive call from the Indiana Medicaid Director,” Yuricich noted in a public statement. “We are very grateful for the delay and look forward to working collaboratively with the agency to address our concerns. A huge thank you to our national partners — AAHomecare, NCART, and VGM — as well as Great Lakes leaders who engaged quickly and diligently given the significant impact these changes would have had on Indiana providers and the Medicaid patients they serve.”

“The Indiana HME community deserves a tremendous amount of credit for their determined and well-organized plan to fight back against these cuts in a short time frame,” remarked Laura Williard, AAHomecare’s vice president of payer relations. “When you’re faced with potential cuts of up to 70 percent for some items and just four weeks before implementation, you have to work fast and you have to work smart – and that’s just what the Indiana team did.”

“We did not have much success in engaging Indiana Medicaid staff early on and getting responses to a myriad of unanswered questions related to the proposed cuts, but we kept applying pressure on several fronts to get the attention of senior leadership,” said Chuck Williams vice president of HME Operations for Williams Bros. Health Care Pharmacy. “Enlisting support from state legislators and influential referral sources, including pediatric pulmonary clinicians, was critical to turning the tide.”

 “This effort will give us time to meet with and further educate state officials, advocate for less severe cuts, and have a transition plan in place before any actual implementation,” added Paula Koenig, executive director of compliance, M&A and special projects with Numotion. “We have a lot more work to do, but we have the attention of the state Medicaid director, and I am confident we will be able to improve upon the initial proposal.”

To that end, AAHomecare noted in a public statement that it would assist the Indiana team in analyzing requested Medicaid utilization data and providing guidance on how FSSA can comply with CURES requirements while ensuring patient access to HME. Great Lakes is arranging a meeting with the agency to discuss the next steps to take.

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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