Georgia Association of Medical Equipment Suppliers
NEWS & NOTES


April 12| 2018

In this issue:

  1. DME Licensure is really here
  2. Blue Cross & DME in the News!
  3. Register TODAY!
  4. Healthcare in the News
  5. National Legislative Priorities
  6. Save these dates!

GAMES Platinum Members!









GAMES Associate Members
Support the associate members who support GAMES. If your vendors aren't on the list, ask them why!


Platinum


Airgas Puritan Medical
Christa Forrester
Mark Bradshaw



Drive DeVilbiss Healthcare
Joe Gessner
Steve Wakser




Philips Respironics
Susan Yenney


ResMed 
Jamie Griffis


VGM Group
Gil McCall
Pat Aydelott


Gold

BREAS 
Todd Tyson

Brightree
Melinda Mahoney

CAIRE

Lanier Hogan

Fisher & Paykel
Gregg Stahl

GCE Healthcare
John Lewis

Mediware
Michelle Caldwell

O2 Concepts NEW Member!
Ed Marlowe

The Compliance Team, Inc.
Jack Haire
Sandra Canally

The MED Group
Ted Metcalf

Silver

ACHC
Randy Hughes

Allegiance Group

Bruce Gehring

Compass Health
Jim Mahon

Integrated Medical Systems (IMS)
Bo Lanier

McKesson Medical Surgical
Chip Wooten

Medical Specialties Distributors
Pat Burke

Medical Supplies Depot
Charles Simpson

Merits Health Products
NEW Member!
Elizabeth McKinley

Pride Mobility Products
John Storie

Quality Medical Inc.
Jim Worrell


Bronze

Medsolve Health Systems
Shane Morrison

Medtrade
Keving Gaffney

Pharmacists Mutual Insurance 
Hutton Madden



Yes, DME Licensure in Georgia is For-Real!

 .....And the Pharmacy Board inspectors show up packing a gun...

DME Licensure became the law in Georgia almost a year ago! But many providers are still wondering if it is true. Well, yes, it is.  Click Here to review SB41, giving the Georgia Board of Pharmacy authority to license anyone providing DME equipment and supplies to patients in Georgia.

With only a few narrow exceptions, the law also requires anyone serving DME patients in Georgia to have a location within the state of Georgia.

Providers are asking, "when do they start enforcing this? When do I really have to get a license?" The answer is that this is current law. Inspectors have already visited a few DME providers.


 

 And off the record, GAMES has learned that some payors are planning to enforce this requirement beginning in October.

If you want to continue serving patients in Georgia - and getting paid for it -don't delay! Get started on your application! Right now this process is taking 3-4 weeks, but if you wait until the volume of applications increases, your application could be delayed.

CLICK HERE for the most recent posting from the Georgia Board of Pharmacy.


GAMES Members' Frustration with Blue Cross of GA Makes the News!

Home medical equipment firms say Blue Cross squeezing them

From Georgia Health News

Piedmont Healthcare isn’t the only entity battling Georgia’s biggest health insurer over reimbursement rates.

Companies that supply medical equipment to home care patients say they have seen double-digit percentage rate reductions from the insurer, Blue Cross and Blue Shield of Georgia.

MRS Homecare, based in Albany, says it faces a 17 percent to 33 percent pay reduction for home oxygen and sleep apnea equipment from Blue Cross.

The CEO of MRS Homecare, Tyler Riddle, said this week that Blue Cross is cutting the company’s rate with a "take-it-or-leave-it’’ fee schedule. His company, with 11 locations in Georgia, also supplies wheelchairs, hospital beds, ventilator equipment and other medical products to home care patients.

Another Georgia medical equipment supplier, Valdosta-based Barnes Healthcare Services, said it also has been hit by double-digit Blue Cross rate cuts.

Blue Cross, meanwhile, is mired in a contract stalemate with Atlanta-based Piedmont. On April 1, the former contract between the two organizations ended, and since then, Piedmont doctors and hospitals have been out of network for Blue Cross members. The deadlock involves payment rates for Piedmont facilities and providers, with the insurer offering what it calls a "fair’’ reimbursement increase to reach a new deal. (Here’s a GHN article this week on the contract snags.)

The durable medical equipment (DME) industry has been already rocked by changes in payments. Several years ago, Medicare shifted to a competitive bidding system for DME companies in urban/suburban areas, and then added set pricing for rural patients in 2016.

The changes, Riddle says, have led to a decrease in the number of independent medical equipment supply companies. Some are simply "closing up shop,’’ he says, while others have managed to find larger firms to buy them. READ MORE...


GAMES 2018 Spring Meeting: Back-Seat Driving!
 
Wednesday, May 9, 2018
Embassy Suites, Perimeter Center
Atlanta, GA

This educational content is presented for owner / operator, senior staff, compliance, and billing supervisors.

Bringing Your Back Office to the Forefront of Success!

Presented by Laura Williard, AAHomecare and Kim Cook, MED Group

We all know the payer environment is shifting away from traditional Medicare and fee for service Medicaid.   Contracts with managed care and commercial payers has become increasingly important to the success of your company.  This session will discuss strategies on building and maintaining these payer relationships which will ultimately help in initial and ongoing contract negotiations.  Learn what things beyond price should be included in your contract discussions and what data you should be prepared to present.



Laura Williard is the senior director of payer relations for the American Association for Homecare. She has served in the HME community for more than 24 years.


Kim Cook is payer development and contracting at The MED Group. She has served in the HME/Home Health/Home Infusion industry since 1997.  


Attend this session and more at the GAMES Spring Meeting!!

CLICK HERE
to register online now! 


CLICK HERE
for a registration form to print and mail or fax. 

Healthcare in the News

These stories are straight from the headlines in Georgia this week! 

Home medical equipment firms say Blue Cross squeezing them
Piedmont Healthcare isn't the only entity battling Georgia's biggest health insurer over reimbursement rates.

GSU Gets Grant To Help Improve Care For Nursing Home Residents
Georgia State University is receiving $1.6 million to improve the care of people living in nursing homes in the state.

Rural health care and the coming GOP collision with reality
Georgia Republicans with November ambitions have just escaped one come-to-Jesus moment.

Blue Cross, Piedmont claim progress, but no breakthrough
Blue Cross and Blue Shield of Georgia and Piedmont Healthcare each said Tuesday that they're making progress in negotiations to reach a new contract.

Legal marijuana lowers opioid use, UGA researchers say
Legalizing medical marijuana appears to lead to less prescription opioid use, and could help curb the national opioid epidemic, a University of Georgia research study finds.

In final minutes, Georgia lawmakers OK'd favored insurance bill
In the final minutes of the 2018 session, the Georgia House quietly ended a three-year fight to pass legislation making sure insurance agents receive a commission when they sell health coverage. 


National Advocacy Priorities for April and May Come into Focus

From AAHomecare, Wednesday in Washington, April 11, 2018

HME stakeholders are encouraged to engage their legislators in the upcoming weeks to keep up the pressure on HHS & CMS to move the IFR and to include long term bidding reforms in the next round of bidding.  Specifically, we're asking the HME community to deliver these messages to Capitol Hill:

1) Following Up on the Omnibus Bill: Recent Omnibus report language "encourages CMS to promulgate the pending Interim Final Rule entitled Durable Medical Equipment Fee Schedule, Adjustments to Resume the Transitional 50/50 Blended Rates to Provide Relief in Non-Competitive Bidding Areas.”  Please contact CMS and ask that they expedite release of the IFR or take similar action that provides timely and substantive relief for home medical equipment suppliers in non-bid areas.

2) Next bidding round: As CMS/HHS prepares for the next bidding round, we urge you to include these common-sense reforms to ensure more accurate price discovery and to ensure patient access to HME products and services:

  • Use market clearing price to determine Single Payment Amount for any item included in competitive bidding.
  • Use historical claims data to determine supplier capacity.
  • Increase transparency of the competitive bidding program.
  • Reform competitive bidding product categories.
  • Remove CMS’ authority to move forward with bundled payments for CPAP and standard power wheelchairs.
3) Implementing CURES provisions: Dec. 2016 CURES legislation required CMS/HHS to reissue payment regulations for items and services furnished on or after January 1, 2019, with adjustments to the non-bid fee schedule in some areas based on stakeholder input, costs, volumes, and numbers of suppliers serving those areas.  Please provide an update as to how the Agencies are substantively addressing this guidance.

AAHomecare will be providing sample letters and guidance for you to use on these issues with your legislators in the coming weeks.  

We hope to generate significant momentum and awareness for these messages (and also continue to build support for HR 4229) in the weeks running up to the Washington Legislative Conference, May 23-24 (see below).  With mid-term elections on tap for this Fall, it’s critical that we get Congress’ attention this Spring and early Summer!

Save These Dates!

Medicaid Fair
April 25, 2018
Tifton, GA

GAMES 2018 Spring Meeting
Back-seat Driving!
May 9, 2018
Atlanta, GA

GAMES 2018 Annual Meeting
September 9-11, 2018
The DeSoto 
Savannah, GA