INDIANAPOLIS, Ind. (October 3, 2019)—HME stakeholders have persuaded Indiana Medicaid authorities to hold off deep reimbursement cuts along a broad range of HME products that were scheduled to go into effect on Oct. 1. The reversal follows a vigorous response to the proposed cuts from Indiana HME suppliers, along with the Great Lakes Home Medical Services Association (Great Lakes), AAHomecare, and other industry groups.

The proposed cuts, first announced in early September, would have cut rates to match the lowest Medicare allowable for more than 2,000 HCPCS codes and severely impacted patients, providers and the Indiana continuum of care.

After the surprise Sept. 3 announcement from the state's Family and Social Services Administration (FSSA), Great Lakes and leaders from the Indiana HME community mobilized to address the cuts. Within days, the Indiana stakeholders, with support from AAHomecare, NCART and VGM, developed plans to push back against the cuts through multiple avenues, including:

  • Requesting the CMS regional office to delay approving the state's Medicaid plan amendments pending further analysis;
  • Meeting with FSSA provider relations staff;
  • Mobilizing Indiana HME providers and referral sources to engage state legislators to reach out to FSSA to ask for a delay;
  • Exploring a public relations campaign with Indiana media outlets;
  • Researching a potential legal challenge and call for a temporary restraining order to delay cuts; and,
  • Repeated outreach, information sharing, and requests for meetings with the FSSA director and assistant director.

The outreach to the top FSSA officials explained how the proposed cuts went far beyond requirements mandated by the 2016 Cures Act, offered to assist with analysis of how Indiana could comply with Cures provisions without across-the-board cuts (as AAHomecare has been able to do in more than 20 other states), and explained how the cuts would severely impact Indiana Medicaid beneficiaries and the HME community. Great Lakes also let the agency know that it was prepared to draw significant media attention to the issue—even sharing a draft of a press release detailing the likely consequences of the proposed cuts for HME patients and caregivers.

Late in the day on Friday, Sept. 27, Indiana FSSA leaders let Great Lakes executive director Kam Yuricich know that the agency would not be implementing the proposed cuts, pending further review and analysis.

"This was a full team effort from the day the announcement was made to last Friday when I received the positive call from the Indiana Medicaid Director," noted Kam Yuricich, Great Lakes executive director. "We are very grateful for the delay and look forward to working collaboratively with the agency to address our concerns. A huge thank you to our national partners—AAHomecare, NCART, and VGM—as well as Great Lakes leaders who engaged quickly and diligently given the significant impact these changes would have had on Indiana providers and the Medicaid patients they serve."

"We did not have much success in engaging Indiana Medicaid staff early on and getting responses to a myriad of unanswered questions related to the proposed cuts, but we kept applying pressure on several fronts to get the attention of senior leadership," said Chuck Williams vice president of HME Operations for Williams Bros. Health Care Pharmacy. "Enlisting support from state legislators and influential referral sources, including pediatric pulmonary clinicians, was critical to turning the tide. It took a great team effort and utilizing every resource available to get the agency to agree to a delay under a fast-approaching deadline."

"I am so proud of the way Indiana HME providers and our association partners stepped up to meet this challenge by taking part in planning sessions and raising the volume on this issue with Medicaid officials and state legislators," added Paula Koenig, executive director of compliance, M&A and special projects with Numotion. "This effort will give us time to meet with and further educate state officials, advocate for less severe cuts, and have a transition plan in place before any actual implementation. We have a lot more work to do, but we have the attention of the state Medicaid director and I am confident we will be able to improve upon the initial proposal."

"The Indiana HME community deserves a tremendous amount of credit for their determined and well-organized plan to fight back against these cuts in short time frame," remarked Laura Williard, AAHomecare vice president of payer relations. "When you're faced with potential cuts of up to 70% for some items and just four weeks before implementation, you have to work fast and you have to work smart—and that's just what the Indiana team did."

AAHomecare will assist the Indiana team in analyzing requested Medicaid utilization data and providing guidance on how the state can comply with Cures requirements while ensuring patient access to HME. Great Lakes is currently working with FSSA to schedule a meeting and discuss next steps going forward.

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