ATLANTA — When it comes to home medical equipment, government agencies have never been known for their promptness or clarity on notification or guidance for new policies.
In Georgia, providers were notified Dec. 28 that the face-to-face requirement under the Affordable Care Act would be effective Jan. 1, 2011, when serving the state's Medicaid patients.
Under the nation's new health reform law, Medicare beneficiaries are required to have an in-person doctor's visit in order for a physician to prescribe any items of DME. The face-to-face exam must be within six months of the physician order. The Department of Health and Human Services also can apply the requirement to items paid for under state Medicaid programs.
The Georgia Association for Medical Equipment Suppliers has asked for a delay in the state's implementation until major questions about the new policy can be resolved: "Can you offer clarification on the new face-to-face requirement? How should the doctor visit be noted in the provider's records? Do we need to submit this to anyone? Does this requirement apply to disposable supplies? Enteral nutrition? Wheelchair repairs?"
State association members have pointed out their concerns about the "burdensome" requirement to officials at the state's Department of Community Health, according to GAMES Executive Director Teresa Tatum, but so far, there have been no answers.
"The only response we got back was an email that said 'the requirement stands as is,'" Tatum said.
Although CMS has issued no guidance on the new requirement, state personnel have indicated Georgia's Medicaid program must be compliant with the federal law, Tatum said. "But how do you actually do it?" she wondered. "The doctor and the patient have to make it happen, but how do we enforce it?"
The association has requested that the issue be addressed at the next meeting of the state's Medical Care Advisory Committee. In the meantime, Tatum said, the new requirement puts providers in the middle and leaves them holding the bag.
Georgia's Medicaid providers have also been left hanging with a reimbursement issue on claims for Medicare-Medicaid dual eligibles, Tatum said. When the state changed processors to HP Enterprise Services last year, payments for the crossover claims stopped.
"We're not getting responses from DCH or HP about the claims," she said. "It's just another frustrating situation where we're caught in a circle and getting no answers."