Minnesota Medicaid proposes ‘claw back’

 - 
Friday, February 22, 2019

SAINT PAUL, Minn. – A meeting in early February between HME stakeholders and Minnesota Medicaid officials on how to comply with a provision in the 21st Century Cures Act that requires Medicaid reimbursement not to exceed Medicare allowables ended in a stalemate.

The state had initially sought input from HME stakeholders on its plan to implement a “claw back” for payments stretching back to Jan. 1, 2018.

“It was determined that we would no longer discuss Cures for we weren't getting anywhere and they deem that only the legislature can fix it,” said Rose Schafhauser, MAMES executive director.

At issue in Minnesota: Officials say, under state statute, they must pay providers at the current Medicaid fee schedule rates—which is higher than Medicare—and then recoup the money every year.

“They will continue to pay those rates and then take back the money when they calculate how much money will need to be paid back to the federal government,” said Schafhauser.“We asked where in the statute it gives them the authority to go back and claw back money all the way to Jan 1, 2018, and they say it’s just a given.”

States around the country have been adjusting their fee schedules to comply, either by basing their Medicaid rates on Medicare’s lowest fee schedule amount or using aggregated data based on Medicaid and utilization rates for 2018. Although not all states have finalized their plans, Minnesota is the only state so far to propose a claw back, and the only one to seek repayment all the way back to Jan. 1, 2018, says Laura Williard, vice president of payer relations for AAHomecare.

“We will see what other states end up doing if they have to pay back,” she said. “However, in most cases they would have to file a retroactive State Plan Amendment change to do this and I don’t think most will do this based on my conversations.”