Medicaid Reprieve for Kansas Providers

TOPEKA, KS — Thanks to an effort by Kansas providers, the
Midwest Association of Medical Equipment Services and the VGM
Group, HME providers in the state are operating under a better
Medicaid situation — at least for the next 12 months.

It all started when Kansas Gov. Mark Parkinson enacted a
sweeping 10 percent Medicaid cut late last year. Along with the
cut, state regulators at the Kansas Health Policy Authority began
reimbursing providers for the lesser of two numbers: either 35
percent above cost, or 80 to 85 percent of the manufacturer’s
suggested retail price.

Greg Packer, vice president of U.S. Rehab for Waterloo,
Iowa-based VGM, said many complex rehab providers could not afford
to serve Medicaid customers under that funding model. After six
months, KHPA regulators agreed. “Once we got them to understand
that there were children in the state who were not getting the
complex rehab products they needed,” said Packer, “state officials
were much more open to conversation.”

Packer, who served three terms in the Kansas legislature, worked
with some of his former colleagues during negotiations with the
state to help MAMES’ Kansas members “make the connections needed to
communicate the issues about the effects the reimbursement cut had
on access to complex rehab equipment for Medicaid recipients,” said
Rose Schafhauser, executive director of MAMES.

Under the new agreement, KHPA will pay 75 percent of the MSRP
and conduct annual reviews of the prior year’s reimbursement rates
to determine if adjustments are needed. With “reasonable” Medicaid
reimbursement again now a reality for custom-seated wheelchairs,
Packer said it’s the perfect time to reflect and apply lessons
learned.

While the victory may only be temporary (12 months and then a
review), Packer believes the Kansas Medicaid battle stands as a
message to providers that negotiation can work, and sitting on the
sidelines is not an option. “You need to be active at the state
level as well as the federal level,” said Packer.

“The end users [Kansas patients] were without service for more
than six months. The lesson here is that no matter whether times
are good or bad, keep in contact with decision-makers and
reimbursement staff at the state level. Doing that can help prevent
lapses in service to patients who need it the most.”

MAMES Vice President Gerald Sloan, owner of Progressive Medical
Equipment in Lenexa, Kansas, agreed. “This is a victory,” he told
the American Association for Homecare. “More than anything, it
shows what can be accomplished when all providers are on the same
page and work together toward a common goal … We unified for
the sake of fair and reasonable reimbursement rates. I believe this
is a story every state association and complex rehab association
should look to for guidance in future negotiations with insurance
companies, the states and Medicare.”