South Carolina: HME stakeholders buy time

COLUMBIA, S.C. - A group of HME providers in January successfully stalled the state's attempt to use a single-source provider for incontinence supplies for Medicaid recipients.

The state had awarded a contract to Long Term Care Inc., based in Several, S.C., but it was forced to scrap it after the group of providers filed protests.

"There was an agreement between all parties to stop the bid and stop the protests and kind of start over," said Ken Wells, one of the owners of Tucker-Wells Medical in Florence, S.C., and one of the protesters. "There were problems for everyone involved."

Those problems were mainly structural, like whether the contract excluded some areas of the state.

The big question now: Will the state just tweak the contract and put it back out to bid? Or will the group of providers be able to convince the state to support an alternative that would cut reimbursement for incontinence supplies by 15%?

Depends who you talk to.

Dewey Roof, vice president of Long Term Care Inc., said the state is tweaking the contract and plans to put it back out to bid in 45 to 60 days.

"There's no doubt about it," he said. "That state has made it plain and clear that this is something they have to do and they're moving forward with it. When we realized that, we put all of our chips on the table."

But other providers say, not so fast.

"We've met with the state and told them, 'We can offer you a $3 million reduction in cost by reducing the fee schedule on 14 items,'" said Dan Gooch, one of the owners of Pal-Med in West Columbia, S.C., and president of the South Carolina Medical Equipment Services Association (SCMESA). "They'd love to take it."

So what's the problem? State lawmakers have included a proviso or condition in the Medicaid budget that prevents the state from increasing or decreasing reimbursement.

"They did it to stop from dropping doctors' rates," Wells said. "It's one of those laws of unintended consequences."

And so now, the group of HME providers is lobbying state lawmakers to exempt incontinence supplies from the proviso.

"When they threw out the bid award it bought them some time," said Bobby Horton, executive director of SCMESA, which is stuck in the middle between providers who support and oppose the contract. "We just don't know which way they're going to go with this."