Cures Act-mandated cuts would have results in a $10 million shortfall in the state.

Via AAHomecare, WASHINGTON, D.C. (February 28, 2018)—When CMS released guidance for states to comply with CURES-mandated Medicaid reimbursement cuts in late December, Georgia Deparment of Community Health (DCH) officials signaled their intention to go with what CMS called the simplest option: to base Medicaid rates on the Medicare fee schedule.

Leaders at the Georgia Association for Medical Equipment Suppliers (GAMES) quickly mobilized to address the challenge. Initially, DCH had estimated that adopting an aggregate pricing approach would cause a $10 million shortfall for the state, but thanks to strong engagement by GAMES, who provided further analysis of the CURES provisions and highlighted updated guidance from CMS, Georgia Medicaid found they were actually under the aggregate model without incurring any fee schedule changes. This dramatic change allowed Georgia Medicaid chief Blake Fulenwider to tell GAMES that the state would be able to avoid the deep cuts that would have come with simply adopting Medicare rates. In addition, DCH will be completing mass adjustments for providers who were originally reimbursed at the Medicare rates during the first part of 2018, before the Agency reversed course.

“We appreciate DCH’s willingness to keep an open mind and work towards a solution that benefits both patients and Georgia taxpayers,” said Tyler Riddle, vice president of MRS Homecare and president of GAMES.

“We’re fortunate to have a partner at the state level who understands the importance of maintaining a viable HME infrastructure to provide cost-effective care that can help keep seniors and people with disabilities in their homes,” adds Charlie Barnes IV, CEO of Barnes Healthcare Services and GAMES president-elect. “We could use more of that kind of thinking at CMS.”

AAHomecare’s Laura Williard, who also serves on the GAMES board, helped the Georgia team craft their arguments and was part of meetings with Georgia DCH. AAHomecare’s efforts to get CMS to quickly clarify the HCPCS affected under the CURES provisions also proved important to the effort.

GAMES executive director Teresa Tatum remarked, “Teamwork is what carries the day in dealing with tough challenges like these, and Georgia HME providers are fortunate to have such a passionate group of volunteer leaders looking out for their interests.” She also noted that successes like these often also owe a lot to building strong relationships over time:

“I appreciate how challenging it can be for our industry to get access to and to educate the right people within Medicaid Departments. We’re fortunate that we started working with Blake Fulenwider almost a decade ago when he was part of Rep. Nathan Deal’s staff in D.C., with HME providers from Georgia engaging him on competitive bidding and other issues at AAHomecare’s annual legislative conferences. It’s a great reminder that the work you put in building credibility with legislators and regulators over time can return important dividends in the long run. If we have more providers getting involved in advocacy efforts through their state associations and AAHomecare, I believe we’ll get even better public policy outcomes for our entire industry.”

You can see some of the arguments GAMES used in their advocacy with Georgia regulators in this letter to DCH.

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