WASHINGTON, DC – AAHomecare has been working for many months with CMS and the Jurisdiction D Council to fix a claims system problem related to physician’s PECOS enrollment. When the requirement was introduced in 2013 that a prescriber ordering DMEPOS had to be enrolled in PECOS, AAHomecare lobbied that a prescriber who dis-enrolls due to death or retirement should have an extension of their termination to allow DMEPOS claims to process for one year.
CMS concurred and actually set the termination date at 13 months to allow for capped rental items to be billed through the cap. In 2014, the system setting was reversed and no longer allowed this grace period. Recently, AAHomecare officials were advised that CMS has implemented a system fix as of March 5, 2018 to once again allow. Suppliers are advised that they can resubmit claims that were denied for this reason as long as they are within the timely filing limit.
GAMES and AAHomecare Partner to Help Stop Medicaid Cuts in Georgia
WASHINGTON, DC – When CMS released guidance for states to comply with CURES-mandated Medicaid reimbursement cuts in late December, Georgia Dept. of Community Health (DCH) officials signaled their intention to go with what CMS called the simplest option: to base Medicaid rates on the Medicare fee schedule.
Leaders at the Georgia Association for Medical Equipment Suppliers (GAMES) quickly mobilized to address the challenge. Initially, DCH had estimated that adopting an aggregate pricing approach would cause a $10 million shortfall for the state, but thanks to strong engagement by GAMES, who provided further analysis of the CURES provisions and highlighted updated guidance from CMS, Georgia Medicaid found they were actually under the aggregate model without incurring any fee schedule changes. This dramatic change allowed Georgia Medicaid chief Blake Fulenwider to tell GAMES that the state would be able to avoid the deep cuts that would have come with simply adopting Medicare rates. In addition, DCH will be completing mass adjustments for providers who were originally reimbursed at the Medicare rates during the first part of 2018, before the Agency reversed course.
“We appreciate DCH’s willingness to keep an open mind and work towards a solution that benefits both patients and Georgia taxpayers,” said Tyler Riddle, vice president of MRS Homecare and president of GAMES.
“We’re fortunate to have a partner at the state level who understands the importance of maintaining a viable HME infrastructure to provide cost-effective care that can help keep seniors and people with disabilities in their homes,” adds Charlie Barnes IV, CEO of Barnes Healthcare Services and GAMES president-elect. “We could use more of that kind of thinking at CMS.”
AAHomecare’s Laura Williard, who also serves on the GAMES board, helped the Georgia team craft their arguments and was part of meetings with Georgia DCH. AAHomecare’s efforts to get CMS to quickly clarify the HCPCS affected under the CURES provisions also proved important to the effort.
GAMES executive director Teresa Tatum remarked “Teamwork is what carries the day in dealing with tough challenges like these, and Georgia HME providers are fortunate to have such a passionate group of volunteer leaders looking out for their interests.” She also noted that successes like these often also owe a lot to building strong relationships over time:
I appreciate how challenging it can be for our industry to get access to and to educate the right people within Medicaid Departments. We’re fortunate that we started working with Blake Fulenwider almost a decade ago when he was part of Rep. Nathan Deal’s staff in DC, with HME providers from Georgia engaging him on competitive bidding and other issues at AAHomecare’s annual legislative conferences. It’s a great reminder that the work you put in building credibility with legislators and regulators over time can return important dividends in the long run. If we have more providers getting involved in advocacy efforts through their state associations and AAHomecare, I believe we’ll get even better public policy outcomes for our entire industry.
You can see some of the arguments GAMES used in their advocacy with Georgia regulators in this letter to DCH.
AAHomecare in Action
Jay Witter, senior vice president of public policy, attended the Indiana State Society Pence Tribute Gala and met with Rep. George Holding (R-NC) and Rep. Adrian Smith’s (R-NE) office…Laura Williard, vice president of payer relations, participated in an Association for Tennessee Home Oxygen and Medical Equipment Services Board meeting, a subgroup of the Atlantic Coast Medical Equipment Services Association board, and a Northeast Medical Equipment Providers AssociationTeleconference on CareCentrix…Williard met with South Carolina Medicaid on the Consolidated Appropriations Act and with Midwest Association for Medical Equipment Services & Supplies on the Missouri Medicaid Budget and 21st Century CURES as well as strategy on North Dakota implementation of CURES…Kim Brummett, vice president of regulatory affairs, and Mina Uehara, manager of regulatory affairs, met with Jeannine Mar from Go Scrips to discuss E-prescribing initiatives and potential collaboration, and participated in a call to discuss the E-Clinical CMS initiative…Brummett participated in a conference call to discuss a response to the President’s Budget…AAHomecare’s Complex Rehab and Mobility Council, Medicaid CRT CURES committee, and the Open Access Work Group convened…