Cures Act update: Could bill in Minnesota serve as template for relief?

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Monday, April 3, 2017

ST. PAUL, Minn. – Minnesota could be the first state to introduce legislation to stave off a “pay for” in the 21st Century Cures Act that limits the federal portion of Medicaid reimbursement for DME to competitive bidding-influenced Medicare reimbursement starting Jan. 1, 2018.

Bills have been introduced in both the House of Representatives and the Senate that would direct the commissioner of the state’s Department of Human Services to make supplemental payments for DME that is impacted by the change. The bills state those payments should be no less than the difference between the payments before and after Dec. 31, 2017.

“Take the problems and attrition we’ve seen from the bid rates for Medicare and expand that to a whole other sector of the population—Medicaid,” said Sarah Anderson, vice president of sales and third party services for Key Medical Supply in Shoreview, Minn., and a board member of the Midwest Association for Medical Equipment Services. “It’s just unsustainable.”

Stakeholders suffered a setback in March, when omnibus bills were introduced in the House and Senate without language on supplemental payments for DME.

The omnibus bill in the House, however, includes what stakeholders call a “toehold” that keeps their efforts alive: a provision requiring DHS to study the impact of limited payment rates for DME on access. DHS must report on results by Feb. 1, 2018.

“The work is not over,” said Rose Schafhauser, executive director of MAMES, which is working on setting up meetings with Conference Committee members who are working to combine the two omnibus bills.

While cost is always a factor in getting legislation passed, stakeholders have so far successfully argued that the DME benefit has hit rock bottom. That’s something they’ll continue to argue.

“The bid rates don’t even cover the cost of acquisition,” Anderson said.

Also working in stakeholders’ favor is their good working relationship with DHS. They have worked with the agency to craft this most recent language, and they have worked with the agency in the past to prevent bid-influenced Medicare reimbursement from affecting Medicaid reimbursement for items included in the program.

“DHS and our legislature are very familiar with competitive bidding and the potential harm to providers and their patients,” Anderson said. “We’ve been working for years to continually separate (Medicaid and Medicare).”

MAMES has shared the language with other stakeholders, in the hopes that similar bills can be introduced in other states.

“We’re trying to be proactive,” Schafhauser said. “The general feedback we’re getting from state legislatures has been good. We’re not asking for an increase; we’re just asking not to go back.”