Georgia Association of Medical Equipment Suppliers
NEWS & NOTES


February 15 | 2018

In this issue:

  1. Update on CURES / Medicaid
  2. CB for Rural Providers?
  3. Healthcare in the News!
  4. Proposed Budget & DME
  5. Licensure application posted
  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
Renewed 2018!
Christa Forrester
Mark Bradshaw



Drive DeVilbiss Healthcare
Renewed 2018!
Joe Gessner
Steve Wakser




Philips Respironics Renewed 2018!
Susan Yenney


ResMed Renewed 2018!
Jamie Griffis


VGM Group
Gil McCall
Pat Aydelott


Gold

BREAS  Renewed 2018!
Todd Tyson

Brightree Renewed 2018!
Melinda Mahoney

CAIRE Renewed 2018!

Lanier Hogan

Fisher & Paykel Renewed 2018!
Gregg Stahl

Cryogenic Inventory Solutions
Anne Holcombe
Travis Caulk


Mediware
Renewed 2018!
Michelle Caldwell

The Compliance Team, Inc.
Renewed 2018!
Jack Haire
Sandra Canally

The MED Group
Ted Metcalf

Silver

ACHC Renewed 2018!
Randy Hughes

ACU-Serve
John Stalnaker

Allegiance Group Renewed 2018!

Bruce Gehring

ABC Plus
Marcus Kruk

Barbara's Billing & Consulting
Barbara Penzien

Compass Health Renewed 2018!
Jim Mahon

GCE Healthcare
John Lewis

Integrated Medical Systems (IMS)
Renewed 2018!
Bo Lanier

Linde Healthcare
Clay Stalnaker

McKesson Medical Surgical
Renewed 2018!
Chip Wooten

Medical Specialties Distributors
Renewed 2018!
Pat Burke

Medical Supplies Depot
Renewed 2018!
Charles Simpson

Medline

Brian Topchik

Medtronic
Chris Arapoff

Merits Health Products
NEW 2018!
Elizabeth McKinley

Pride Mobility Products
Renewed 2018! 
John Storie

Quality Medical Inc.
Renewed 2018!
Jim Worrell

TestSmarter
 Brad Womble

Verus Healthcare
Rachel Dobyns


Bronze

Medtrade
Renewed 2018!

Keving Gaffney

Pharmacists Mutual Insurance 
Renewed 2018!
Hutton Madden



Update on CURES & GA Medicaid!

As previously shared,
 citing a more than $10 million shortfall in federal dollars due to implementation of the 21st Century CURES Act, Georgia Medicaid announced plans to adopt Medicare Bid rates for DME effective January 1, 2018.

The GAMES Board of Directors, with support from AAHomecare, went to work immediately questioning the methods used to arrive at this shortfall and pleading the case for patients who would certainly suffer access issues!. CLICK HERE to see the comments and supporting documentation submitted by GAMES.

The good news?

Medicaid Chief, Blake Fulenwider addressed GAMES members at the GAMES / GRTC 2018 Winter Meeting January 30th in Decatur where he shared that based on input from GAMES, and additional guidance received from CMS, the department (DCH) performed further analysis on the expected impact of CURES. He further shared (verbally) that this additional analysis indicates the shortfall to be closer to $300,000 than the previously determined 10+million. Georgia is under the CMS "aggregate" and the Medicaid fee schedule will not need to change.

BUT My Medicaid EOB's reflected a new fee schedule based on Bid rates - and my cash flow is suffering!

After receiving calls from members, GAMES leadership hopped on a call yesterday with representatives from GA Medicaid to learn more. What we understand is this: Prior to the additional analysis (as explained above), Medicaid had already implemented this new fee schedule (based on Bid rate) to begin on Jan 1, 2018. Currently Medicaid is working to adjust the fee schedule and process claims at the appropriate rate (to reflect the Oct. 1, 2018 schedule). A mass adjustment is forthcoming. At this time, we do not have a date for this mass adjustment.

Your GAMES Board, along with assistance from newly hired government consultant, Jenee Burke, will continue to engage with Medicaid and keep members updated.

Is Medicare Bidding Headed for Rural America?

 

 

One of the many numerous arguments we have used to explain why Bid rates don't work in rural areas is the fact that these rural providers had no say-so in the rates! But this isn't exactly the outcome we were hoping for... See below from VGM on what newly named HHS Secretary has to say on the subject of Medicare Bidding in Rural America:

From VGM February 14, 2018

Rep. Adrian Smith (R-Neb.) Discusses DME With Sec. Alex Azar During Hearing

Wednesday morning, the House Ways & Means committee addressed the FY19 HHS budget in which the competitive bidding program was discussed. Rep. Adrian Smith (R-Neb.) called into question whether prices set in urban areas are appropriately applied into remote and rural areas.

Click here to view the clip.

"Another issue that I hear a lot about recently is the deeming of competitively bid prices for durable medical equipment in non-metropolitan areas. In particular whether the deemed reimbursement levels are sustainable for providing appropriate service in rural and remote areas,” said Smith.

He continued to ask if CMS, "compared these reimbursements to the cost of actual delivery of DME in rural areas when making this decision.”

In response, Secretary Azar discussed the proposed idea of rural areas being bid and the proposed change in the budget to pay providers what they bid, not the median price of all bids.

As was discussed yesterday, without having any further information, the competitive bid program is highly flawed and applying that same structure to the rural areas of the country would certainly further the substantial reduction in suppliers across the country, leading to more beneficiary access issues.


 Healthcare in the News

Rural health care bill clears House panel
A House committee Tuesday approved high-profile legislation to boost rural health care in Georgia.

Georgia down slightly in 'Well-Being' survey
Georgia dropped from 29th the 31st in a measurement that reflects how people feel about and experience their daily lives.

House panel weighs legislation to ease access to vital medications
Brannen Whirledge was diagnosed with ulcerative colitis, an inflammatory bowel disease, two years ago at age 4.

In rural Georgia, telemedicine provides new options for children's mental health
In more than half of Georgia counties, parents can't find nearby mental health services for their children.

Bill would expand rural nurses' role
The high number of diabetic patients walking through the door overwhelmed Janie McGhin, a nurse practitioner in South Georgia.

Georgia governor slams door on major medical marijuana expansion in 2018
Gov. Nathan Deal said he would oppose an effort to legalize the in-state cultivation of medical marijuana this year, forcing supporters of a major expansion to wait until his successor takes office next year to press their case.

Flu refuses to wane, has now killed 66 in Georgia
Georgia's flu-related death toll this season now stands at 66, with two confirmed child deaths, according to the state's Department of Public Health.

Advocates for the elderly seek funds
Nearly 13,000 people called for help on the Northwest Georgia Area Agency on Aging hotline in the past 12 months, the director testified in Atlanta Thursday.


White House Budget Proposal Includes Rural Bidding Component Among HME-Related Provisions

From AAHomecare February 14, 2018

The recently released FY 2019 budget proposal from the White House includes several items related to DME. AAHomecare has especially strong concerns about the first item noted below and plans to talk to the Administration for clarification.

Provisions found in the budget proposal and an HHS summary document include:

  • Reform and Expand Durable Medical Equipment Competitive Bidding -- This proposal eliminates the requirement under the durable medical equipment competitive bidding program that CMS pay a single payment amount based on the median bid price, and instead, pay winning suppliers at their own bid amounts. Additionally, this proposal expands competitive bidding to all areas of the country, including rural areas. Expanding competitive bidding to rural areas will set prices for items and services in rural areas based on competitions in those areas rather than on competitions in urban areas. In the event that in a rural area less than two suppliers submit bids, CMS will use a reference price from other, similar rural areas. [$6.5 billion in savings over 10 years]
  • Eliminate the Unnecessary Requirement of a Face-to-Face Provider Visit for Durable Medical Equipment-- Currently, physicians must document a beneficiary’s face-to-face encounter with a physician or non-physician practitioner as a condition for Medicare payment for a durable medical equipment order, which can be overly burdensome on providers and suppliers. This proposal enables CMS not to impose this face-to-face requirement on all providers. [No budget impact]
  • Address Excessive Billing for Durable Medical Equipment that Requires Refills or Serial Claims-- This proposal uses Medicare demonstration authority to test whether using a benefits manager for serial durable medical equipment claims results in lower improper payments and reductions in inappropriate utilization. The benefits manager would be responsible for ensuring beneficiaries were receiving the correct quantity of supplies or services for the appropriate time period. [Budget impact not available]
  • Address Overutilization and Billing of Durable Medical Equipment, Prosthetics, and Orthotics by Expanding Prior Authorization-- This proposal expands prior authorization to additional items and services that are at high risk for improper payments. In FY 2016, CMS finalized a regulation that established a master list of items that are both high-cost and high-risk for improper payments and therefore could be subject to prior authorization. This proposal would expand the number of items on the list subject to prior authorization. [Budget impact not available]

With regards to the first item, the infrastructure of the HME sector is fragile enough as it is with a 40% decrease in providers since 2013. The financial pressures are felt by companies dealing with deep reimbursement cuts stemming from the competitive bidding program, the use of bidding-derived pricing in rural/non-bid areas, and through the ripple effect of other MCO payers, Medicaid and TRICARE who use these rates as a guideline. To suggest that there are an additional $6.5 billion in cuts that rural providers can absorb over ten years, on top of the drastic cuts since 2016, is frankly incomprehensible. Access to care is severely threatened in the current Medicare reimbursement environment; there is no room for additional cuts – and, we hope, no stomach for such cuts for Senators and Representatives who will see their constituents severely impacted.

AAHomecare and other HME stakeholders are working to assess these proposals and reach out to our Congressional and regulatory agency contacts for more information on the source and prospects for a "rural bidding program” and the elimination of median bid pricing under CB. 


DME Licensure application is posted to the Pharmacy Board website

Go to: https://gbp.georgia.gov/ and select "applications and forms”. Scroll down until you see "Durable Medical Equipment Suppliers Facility Application - Posted 1/29/18

GAMES president, Tyler Riddle, is looking closely at the application with the intent to address any inconsistencies and submit questions. If you have comments on the application, please go ahead and reach out to the Pharmacy Board. But can you also CLICK HERE to share your comments and concerns with GAMES please. 


Save These Dates!
 
Medtrade Spring
March 28-29, 2018
Las Vegas, NV

GAMES 2018 Spring Meeting:
All things payor related!
May 9, 2018
Atlanta, GA

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