HME providers, Medicaid compromise in Vermont

MONTPELIER, Vt. - HME providers have a “handshake agreement” with the Department of Vermont Health Access to improve Medicaid reimbursement after a number of providers threatened to leave the program.

In January, DVHA published a bulletin outlining its plans to adopt Medicare rates, resulting in a reduction in reimbursement anywhere from 38% to 56%, says Kurt Filiaut, CEO of Keene, N.H.-based Keene Medical Supply, which has six locations in Vermont.

“Certainly, there is still a lot of work to be done,” he said. “We are focusing our efforts on certain product categories that are completely unmanageable.”

A provision in the Cures Act required CMS to cap its contribution to Medicaid reimbursement for DME at Medicare reimbursement starting Jan. 1, 2018. Industry stakeholders have been working to educate state Medicaid programs that they have options other than just adopting Medicare's fee schedules.

Filiaut told DHVA officials in April that he would withdraw from the Medicaid program on June 1. He has agreed to continue serving Medicaid recipients, following an emergency meeting between several providers and DHVA in May.

“We have faith that the DHVA is going to do the right thing, which is to put in a reimbursement level which is livable and avoids an access issue for beneficiaries,” he said.

DVHA also has plans to revise its capped rental policies to better reflect Medicare's policies. One of the biggest changes: CPAPs will transition from a three-month to a 10-month rental. The state, however, did not change policy language that would have allowed providers to bill for supplies.

“We told them that was not sustainable in January and we told them again in March,” said Karyn Estrella, executive director of HOMES. “Companies were taking a loss and a couple of providers told the state they'd have to stop doing Medicaid.”