HME Providers in Virginia Face New Challenges as Medicaid Pricing Goes to Competitive Bidding

AAHomecareSince last year, Medicaid DME reimbursement rates in Virginia have been posted at Medicare minus ten percent. However, things have gotten worse for Virginia DME providers. On July 1, 2014 DME reimbursement rates for Medicaid dropped to the competitive bidding rate on bid items. In some cases, that could be a 40 percent drop in pricing, which will be unsustainable for most businesses.

This is another in a long list of unintended consequences from the ill-conceived Medicare competitive bidding program that will hurt patient access to home medical care equipment and supplies. HME suppliers will be forced to make hard decisions about what insurance plans they accept and whether or not to continue to serve Medicaid patients. Patients could be forced to change providers and have less options when they do.

AAHomecare spoke to Sam Clay, President of Clay Home Medical, Inc, in Virginia and president of Virginia Association of Durable Medical Equipment Companies (VADMEC) about what other states can do prepare for a similar scenario. “The key is to establish relationships with your local legislators early on and to educate them about DME issues as whole, so that when situations like this arise, you are not starting from scratch, said Clay. “It is every provider’s responsibility to stay informed and stay involved.”

VADMEC has invited a representative from Medicaid to discuss the effects of the new fees and other Medicaid issues at their Summer Meeting in Norfolk, VA, July 23-24.

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