Cures update: Georgia Medicaid reverses course

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Thursday, March 1, 2018

ATLANTA – HME industry stakeholders have succeeded in steering Georgia away from basing its Medicaid reimbursement on competitive bidding-based Medicare reimbursement, AAHomecare reported this week.

Initially, the Georgia Department of Community Health indicated that it would just adopt Medicare reimbursement, because an aggregate pricing approach would create a $10 million shortfall. But after the Georgia Association for Medical Equipment Suppliers intervened and provided further analysis, the agency found that adopting the alternate approach wouldn’t cost the state anything.

“We appreciate DCH’s willingness to keep an open mind and work toward a solution that benefits both patients and Georgia taxpayers,” said Tyler Riddle, president of GAMES and vice president of MRS Homecare, in this week’s AAHomecare “Wednesday in Washington” bulletin.

State Medicaid programs across the country are grappling with how to comply with a provision in the 21st Century Cures Act that limits the federal government’s contribution to Medicaid reimbursement for certain DME to Medicare reimbursement.

Additionally, DCH has agreed to complete mass adjustments for providers that were originally reimbursed at Medicare reimbursement during the first part of 2018, before the agency decided to reverse course.

Stakeholders credit a positive, long-standing relationship with DCH for preventing the reimbursement cuts.

“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,” said Teresa Tatum, executive director of GAMES, in the bulletin. “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.”