Reimbursement Cuts to NY Medicaid Incontinence Supplies

One Month Delay in Effect While Further Review Takes Place

Last June, The New York State Department of Health (NYS DOH) announced an ‘Incontinence Supply Management Program’ for all Medicaid beneficiaries that would implement minimum quality standards for incontinence products to take effect on September 1, 2016.  In addition to the quality standards, NY DOH also awarded a preferred vendor contract to TwinMed, LLC for incontinence products to be purchased by Medicaid providers.  Medicaid providers who purchase incontinence supplies from TwinMed, LLC were to receive competitive pricing and an approved formulary by the Department as meeting the new minimum quality standards.

While providers are not mandated to purchase these products from TwinMed, LLC, if they purchase from other vendors, they are required to obtain independent laboratory testing results certifying that the products dispensed meet the minimum quality standards. These results must be maintained by the provider for each product and kept on file for a 6-year period in the event of a pre- and/or post-pay audit.

Both AAHomecare and Northeast Medical Equipment Providers Association (NEMEP) applaud the initiative to provide high quality incontinence products to the NY Medicaid beneficiaries. However, along with these developments, the NYS DOH published fee schedule changes for these products that decreased reimbursement by approximately 30% to go into effect on February 15, 2017.

Laura Williard, AAHomecare senior director of payer relations, developed and performed a mini cost analysis study that evaluated providers’ cost of goods along with operational costs to providing these products.  This aggregate, de-identified information was presented to the Department along with comparisons of current and proposed rates with the average Medicaid allowables across the country and also with the 5 surrounding states.

Kim Voelker, NEMEP executive director, was informed that the implementation of rate reductions would be postponed until March 15, 2017 while further review takes place. Going forward, Voelker and Williard will be meeting with the Department to review the study more fully and to advocate on behalf of providers regarding the sustainability of the cuts.  Voelker comments: “Our collaboration with Laura and AAH enabled NEMEP to provide the Department with solid data illustrating providers’ true costs in supplying these products. We look forward to a continued dialogue and re-evaluation of the reimbursement model."

CMS Double Dips on Oxygen Payments

“Today rural America oxygen payments are lower than urban competitive bid payments - that’s egregious,” president and CEO of AAHomecare, Tom Ryan, said during his interview with DC’s News Channel8.

“CMS has used an old payment methodology and applied it to the new payment methodology, and essentially double dipped.” Ryan stressed the need to fix CMS’ misguided new cuts for oxygen concentrators in rural areas and HME’s important role in protecting patients and lessening costlier clinical interventions.

The HME industry is a service industry and very often when patients who have difficulty getting in and out of their home receive a visit from their oxygen technician or their respiratory therapist, it’s a life line for them. “That’s the ability for that provider to go in, provide the service, and give them the needed medical equipment. And very often [patients] look forward to their oxygen delivery. They like that interaction with the delivery tech when they come in their door.” This interaction and in home visit is an important part of the healthcare safety net that is now becoming more difficult to provide.

Ryan described the need for rational conversations with CMS with good data and a conversation on where homecare can help save Medicare dollars and still provide better care. “Service is the key here and we too often look at things in DC, and particularly at CMS, in silos. We’ve got to break the silos down and not just look at what does it cost you here but what does it cost you across the whole continuum of care.”

View the full interview: http://wjla.com/news/news-talk/the-affordable-care-act-medicare