WASHINGTON, DC – As mandated in the December 2016 CURES bill, federal Medicaid reimbursement to states for home medical equipment cannot exceed what Medicare would have allowed for these items beginning on Jan 1, 2018.
Since the start of this year, AAHomecare has been working with state Medicaid programs, state/regional associations, stakeholder groups, legal counsel, and CMS to obtain guidance and offer direction and recommendations to ensure that the Medicaid programs understand their rights in managing their program and their responsibilities to ensure access to care under these new requirements.
AAHomecare has met multiple times with CMS to obtain information on what guidance will be issued to the states. At the most recent meeting, we obtained additional information related to this notice in the Federal Register published by CMS that Medicaid agencies will need to show they are complying with this regulation by annually reporting their claim payments for specific HCPCS codes which include K and E codes and a few select A codes.
AAHomecare has been informed that a State Medicaid Directors letter will be issued soon with additional guidance. There will also be a State Operational and Technical Assistance call held on December 7 — AAHomecare will be participating and will provide further information.
State Medicaid programs DO NOT have to set their rates at a Medicare allowable. States will continue to have the flexibility to set their own rates to ensure access to care. However, given the fact that the Federal match is being reduced to reflect Medicare rates, we expect many states will feel compelled to lower fee schedules accordingly. AAHomecare will provide support to state/regional association leaders and other stakeholders in advocating for sustainable Medicaid reimbursement rates under these new program requirements.
Access Survey Findings an Important Tool for Outreach to Capitol Hill
WASHINGTON, DC – Reps. Mike Coffman (R-Colo.), Vincente Gonzalez (D-Texas), Betty McCollum (D-Minn.), Mark Meadows (R-N.C.), and Alex Mooney (R-W.V.) joined the list of co-sponsors for H.R. 4229 per this morning’s update. Thanks to HME stakeholders for their continued outreach to members of the House that has brought the current co-sponsor total to 76.
AAHomecare has also been meeting directly with Congressional offices and key committee staff to build support for the bill in recent weeks. As part of these meetings, we have made a point to share the recently completed Patient Access survey and highlight key findings from it, including these findings from the report’s Executive Summary:
Beneficiaries and case managers are experiencing a wide range of quality and access issues, and many suppliers are strained to the point where beneficiaries question their capability to meet their needs.
- 52.1% of beneficiaries report problems accessing DME and/or services
- 88.9% of case managers report an inability to obtain DME and/or services in a timely fashion
Case managers noted that the program has complicated the discharge process and that delays in obtaining DME have often resulted in or contributed to Medicare beneficiaries’ need for emergency care or a hospital re-admission.
- 70.8% of case managers report discharge delays of 1-7 days
- 61.7% of case managers say patients are having medical complications some of which result in readmission to the hospital.
AAHomecare encourages the HME industry to contact your legislators regarding H.R. 4229 and help us continue to increase the number of co-sponsors, sending a message that this legislation is strongly supported throughout Congress. You can use the points above in your discussion as well as the following:
- Stress that this input from 361 case managers/discharge planners surveyed adds a great deal of credibility to these findings. Find the complete report and summary/highlights at aahomecare.org/access.
- You can also include data on the decreasing numbers of HME suppliers and locations in your state since July 2013 in your message to your representative.