Medicaid: NCART gets in the weeds

Association recently added California to list of states in which it engages lobbyists
Friday, October 25, 2019

BUFFALO, N.Y. – Medicaid issues have always been a priority for NCART, but they’re more urgent than ever, says Don Clayback.

With the implementation of the 21st Century Cures Act and the proliferation of managed care organizations, NCART has decided to expand its Medicaid Committee and add California to the list of states in which it engages lobbyists.

“When you look at the CRT population, Medicare is a payer for some, but Medicaid is the bigger payer typically,” said Clayback, executive director of NCART. “So when you look at recent changes, unfortunately, there has been more pressure around Medicaid payment.”

Don’t cherry pick

NCART has found that some states, in adopting Medicare rates to comply with the Cures Act, have not also adopted the agency’s policies.

For example: Per Medicare, the KU modifier means accessories are for a complex rehab wheelchair, not a standard wheelchair, and, therefore, should be paid for using historic rates not bid rates.

“They can’t cherry pick,” Clayback said. “They can’t adopt the Medicare fee schedule but not the modifiers. In essence, our message to the state is, ‘If you’re using Medicare as a reference, you need to adopt it in total.’”

NCART was recently able to get this issue resolved in Nevada.

Save the miscellaneous codes

NCART has also found that a number of Medicaid programs are trying to attach flat rates to miscellaneous codes, which defeats the purpose of those codes and which goes against Medicare policies.

“We’re educating them on why we need to keep those codes individually considered,” Clayback said. “Our preference is to allow providers to submit the item and retail price, and use that price as a reference point.”