West Virginia Lawmakers Send Strong Message on Rural Reimbursement Rates

WASHINGTON, D.C. (July 26, 2018)—This week, West Virginia’s Congressional delegation released a letter to CMS Administrator Seema Verma asking her to address their concerns regarding “the significant cost differences that rural providers face relative to their urban counterparts within the CBAs,” after those issues were not resolved in the DME-related interim final rule released in May.

The letter notes a 38 percent reduction in the number of HME suppliers in the state over the last two years, and also points out that areas CMS designates as rural for DME do not mirror the classification for rural clinics and critical access hospitals in the state. The legislators say this disconnect “creates more issues for keeping the cost of providing care across the continuum low due to lack of access,” and also impacts the number of providers serving Medicaid patients in West Virginia.

Regina Gillispie, president and owner of Best Home Medical played a leadership role in getting the West Virginia lawmakers to weigh in on the issue.

Gillispie, who has been active on Capitol Hill since the advent of the bidding program, has worked to build strong relationships with health care staffers in West Virginia Congressional offices. She has consistently looked for new ways to demonstrate how unsustainable reimbursement rates are impacting suppliers throughout the state. Gillispie also credited Jeanette Lancaster from Mon Home Healthcare and Kevin Milam with The Billing Center for their effective work in engaging their legislators at the most recent Washington Legislative Conference.

To support her arguments that the current rate structure was causing access issues, Gillispie connected Congressional offices with state Medicaid officials, who lent additional credibility to industry assertions that patients and hospital discharge planners are being severely impacted by a dwindling provider base. She also raised the issue of the differences in the areas deemed rural for HME when compared to the areas used to classify access hospitals that serve as a lifeline for rural communities.

“The information about the differences in rural classification made a strong impression on the Congressional offices,” noted Gillispie. “They know those areas well, and they understand how challenging—and critical—it is to deliver quality care outside of metropolitan areas.”

See the West Virginia letter dated July 18, 2018, here.

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