State news: Illinois targets MCOs, Minnesota gets approval from judge

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Friday, September 14, 2018

SPRINGFIELD, Ill. – Proponents say a bill in the Illinois House of Representatives that would address reimbursement cuts for home medical equipment and supplies is critical as more and more payers offer below-Medicaid rates.

This year, IlliniCare Health, a Medicaid MCO, announced rate cuts ranging from 10% to 50%. House Bill 5930 would prohibit MCOs from paying providers less than 10% below Medicaid “fee for service” rates.

“IlliniCare was the first one, but there’s been quite a bit of talk about Blue Cross Blue Shield doing the same,” said Dan Heckman, owner of Heckman Health Care in Decatur. “That makes it even more critical to get it passed.”

The bill, which Heckman hopes gets passed this fall or during the 2019 spring session, would also require “minimum quality standards” for medical supply companies and would prohibit MCOs from signing “sole-source” contracts.

Cutting reimbursement to the point where it doesn’t make sense for providers to be in-network with certain payers would severely curtail beneficiary access, especially outside of the Chicago area, says Heckman.

“The MCOs, in general, don’t have real robust networks in the downstate area,” he said. “When IlliniCare expanded downstate, their initial offer to us was the deeply discounted rate. We just didn’t take it. Nope, not playing that game.”

Minnesota: Judge sides with MAMES on incontinence proposal

SAINT PAUL, Minn. – Industry stakeholders scored a victory in late August when the state tabled its plans to create a preferred provider program for incontinence supplies, but they said the fight isn’t over yet.

MAMES received a temporary restraining order Aug. 24 to delay the program, which would have awarded a single contract to provide incontinence products to Medicaid beneficiaries.

“We are celebrating the temporary win, if you will,” said Rose Schafhauser, executive director. “But, we still have work to do.”

At issue with the program: The reimbursement was calculated at 20% above acquisition cost—not enough for providers to continue to provide products; and, as proposed, it went against other statutes governing reimbursement for state health programs, says Schafhauser.

“The judge concurred and said, ‘Modify this and prove you are filing within the statute,’” said Schafhauser.

Once the restraining order was granted, the state said it would withdraw the RFP.

“Our main goal is to get this program delayed until the next legislative session and get a bill passed,” said Schafhauser.

So far, lawmakers have been on their side. MAMES succeeded in getting legislation passed once already this year, but it was included in an omnibus bill that was ultimately vetoed by the governor.