HME News

FEB 2019

HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o

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State News 4 www. HM e N ew S . C o M / febru A ry 2019 / HM e N ew S INNOVATIVE SOLUTIONS FOR THE FUTURE TECHNOLOGY SNAPSHOTS: Download today at playbook.vgm.com Members download for free! VGM'S LATEST BUSINESS PLAYBOOK INNOVATIVE SOLUTIONS FOR THE FUTURE TECHNOLOGY SNAPSHOTS VGM's latest business playbook is here. By Liz Beau L ieu, e ditor OLYMPIA, Wash. – Only physicians can now order medical equipment for Medicaid recipients, says the Health Care Authority in Washing- ton state. Advanced nurse practitioners (ARN p s) or physician assistants ( p As) ordering medical equipment must have a physician's signature on their requested orders, the Medicaid direc- tor says. "I wouldn't say the majority of the prescrip- tions we receive are from ARN p s or N p s, but there are certain clinics where they are the pri- mary practitioners," said Ryan French, home health director at Jim's p harmacy & Home Health in p ort Angeles, in December, ahead of the new rule going into effect Jan. 1. "I just sent 12 faxes about the change to clinics where they are the prescribers. We don't want our patients to have a lapse in getting their equipment and supplies." In a Nov. 14 letter to stakeholders, the Medicaid director says the state's making the change "to align with federal regulations pub- lished by CMS on Feb. 2, 2016." The change, however, came as a surprise to providers, who noted how, back in 2015, Congress required CMS to expand who can conduct the face-to-face exams required for DME prescriptions to include p As, N p s or clinical nurse specialists. "We saw the change coming, but we thought the uproar that happened when Medicare made a similar announcement on the face-to-face would also happen in this case, but no one seems to be discussing it or complaining," said Dawn Rolph, office manager for In Home Medical in p asco. "It's strange, because it's going to be a problem." The biggest problem: reduced, or at least delayed, access to equipment and supplies, providers say. "It's not frantic right now," Rolph said in December, "but it's going to be when we can't provide people's equipment and they ask, 'Why not,' and we say, 'Because the state changed the rules.'" HME Washington Medicaid restricts who can prescribe kansas By Theresa F L aher T y, Manaing e ditor TOPEKA, Kan. – A proposal to drastically reduce Medicaid rates for DME p OS, published just before the holidays, came as a surprise to stakeholders, they say. The Kansas Department of Health and Environment said it planned to submit an amendment to set the Medicaid fee sched- ule for DME p OS items at 65% of the non- rural Medicare rates. "We have no idea what the rationale behind this is," said Rose Schafhaus- er, executive director of MAMES. "We met with them in February of last year and made them aware then that even going to the Medicare allowable would be problematic." States around the country have been adjusting fee schedules to comply with the 21 st Century Cures Act, which states that the federal portion of Medicaid reimburse- ment for HME cannot exceed what Medi- care allows. States can base their Medicaid rates on Medicare's lowest fee schedule or they can gather aggregated data using their Medicaid and utilization rates for 2018. Drastic rate cut proposed What Kansas is proposing is untenable, says Robert Clock, the state representative to MAMES and CEO of Winfield-based Clock Medical Supply. "I think for most providers this is well below their product costs," he said. "As people assess where they are with their goods and services, to receive a 35% reduction on the Medi- care non-rural rates is unacceptable." That's of particular con- cern in the large swathe of the western half of the state, which is largely rural and already underserved, says Clock. " p atients will have to stay wherever they receive their primary service, usually a rural hospital, which is way too costly," he said. Complicating matters: the transition to a new administration. The Medicaid direc- tor left, new lawmakers are being seated, and a newly elected Democratic governor replaced the outgoing Republican, said Clock. "It's a whole learning curve," he said. HME Schafhauser

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