Ohio Medicaid HME Rules, Fees and Forms In Effect Today

As OAMES has been reporting, seven revised and two new HME rules as well as updated fee schedules and CMN forms, are in effect today for the Ohio Medicaid program after a long delay due to COVID-19.  Refer to 6/24/21 OAMES eBulletin with links to the affected Ohio Department of Medicaid (ODM) rules.

Late Monday, OAMES received ODM’s decision regarding the pricing methodology for certain CRT codes (E2609, E2617 and K0108) that has been an on-going discussion for several months.  Unfortunately, the news was not good and the “cost plus” policy they proposed would have been highly problematic with severe reductions falling short of suppliers’ costs to provide these custom items to CRT clients. 

An urgent call was held yesterday with ODM Policy staff and OAMES and NCART to express strong opposition to their decision.  After a lengthy discussion, the Department agreed to a 60-day extension to work towards an agreeable solution for these specific codes only to preserve access to the items and avoid disruptions to patients. The discussion remains focused on “MSRP minus” versus “Cost plus” pricing methodology.  ODM remains generally opposed to basing rates off of MRSP but is willing to continue working through the details of these two pricing options with OAMES and NCART to reach an acceptable resolution. 

We’d like to thank OAMES president Andy Willhelm, NCART executive director Don Clayback, and the CRT workgroup leaders, for their hard work on this issue over the past few months.  While there is more work to be done, ODM continues to dialogue with our associations.  A thank you as well to the OAMES members who participated in the associations’ data analysis to provide transparency for this discussion.  Their insight and critical perspective on behalf of CRT providers and consumers has been invaluable.  Those companies include:  Advanced Medical Equipment, Health Aid of Ohio, Miller’s Rental & Sales, National Seating & Mobility and Numotion.

Below are additional resources and links to Ohio Medicaid fee schedules and ODM forms (CMNs):

• The DMEPOS Appendix to OAC rule 5160-10-01 with updates to the payment schedule previously shared is also effective today. Link below:

http://www.registerofohio.state.oh.us/pdfs/5160/0/10/5160-10-01_PH_FF_N_APP1_20210621_0829.pdf

• ODM website link to Medicaid provider rates. Scroll down to find three payment schedules under the DMEPOS section – the main list as well as schedules for oxygen and wheelchairs:

https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/billing/fee-schedule-and-rates/schedules-and-rates

• Late yesterday, ODM indicated that the updated CMNs should be posted today on the Department’s website at this link but as of the time of this notice, they have not been. OAMES continues to press the agency to make these forms available ASAP:

https://medicaid.ohio.gov/wps/portal/gov/medicaid/stakeholders-and-partners/legal-and-contracts/forms/forms

If you have any questions on these matters, please contact OAMES executive director Kam Yuricich.   

OAMES Urges Governor and ODM to Prioritize HME Providers for ARPA Funding

Earlier this week, OAMES, in partnership with our national advocates, the American Association for Homecare (AAHomecare) and the National Coalition for Rehab & Assistive Technology (NCART), submitted letters to Ohio Governor Mike DeWine as well as the Ohio Department of Medicaid, urging that as the State deliberates how to prioritize the American Rescue Plan Act (ARPA) recovery funding of nearly $5.4 billion from the federal government, that “home medical equipment services community be considered as a recipient of these important state dollars”.   

The Governor's letter focused on the critical role that HME providers have played throughout the public health emergency in helping reduce the intense pressure on hospitals and clinicians keeping patients safe at home and making the case that relief is needed for the HME community.  Our industry “ask” is to mandate that ODM “allocate a one-time funding amount equaling 10% of the total paid claims for the DMEPOS benefit for dates of service 3/6/2020 through 4/30/2021”.  The timing of this request is difficult with the Governor focused on wrapping up the state budget bill (legislation signed overnight) but we are working with our government relations consultant to stay on top of this issue.

The letter to ODM from OAMES, AAHomecare and NCART addressed a specific section of ARPA that “provides a temporary 10% increase to the State’s FMAP for dates between April 2, 2021 to March 31, 2022”.  Per CMS guidance, States may apply this increase to among other things, home and community-based services (HCBS) which has been broadly defined to include HME.  During OAMES Board of Directors quarterly meeting on 6/24/21, the Board approved the “ask” that “ODM increase the DMEPOS fee schedule by 5% for a two-year period” effective at a future date to be determined (not retro-active).  ODM responded quickly indicating that they had not yet submitted their plan to CMS and agreed to add OAMES to the “list of stakeholders to be consulted” and will be in touch regarding our request to meet. 

OAMES would like to thank Laura Williard at AAHomecare for initiating this work in our states and the collaboration with Don Clayback at NCART.  We’ll keep members updated as we work to achieve this funding for our members who have been, and continue to be, critical front-line workers for Ohioans during the public health emergency and beyond.

FDA Issues “Safety Communication” on Philips Recall

Additional Resources Available from Provider Community

OAMES received an AAHomecare Alert late yesterday announcing that the FDA has issued a "Safety Communication" on June 30 regarding Philips’ recent recall of certain respiratory devices.  As AAHomecare notes, “the FDA communication summarizes major issues and considerations related to the recall, and encourages patients using BiPAP and CPAP machines to discuss treatment options and alternatives with their healthcare providers, including ‘Continuing to use your affected device, if your health care provider determines that the benefits outweigh the risks identified in the recall notification’.”  Click here for more information and important links. 

We’ve also received word that the Medicare Councils for A, B, C and D submitted their final set of questions which was gathered from all jurisdictions and submitted to the DME MACs.  The questions have been acknowledged and we expect a response is forthcoming.  As soon as we receive that information, we’ll pass along to members.  OAMES is a member of the Region B Council and we’d like to thank the staff and volunteers for their efforts and coordination on this important Medicare work.  We’re also aware of efforts by AAHomecare’s Regulatory team working directly with CMS to provide guidance and we’ll continue to share updates as we learn more from our national association. 

You should also be aware that the DME MACs jointly issued a series of FAQs (CGS at Juris B posted 6/28/21).  Industry consultant Andrea Stark with MiraVista LLC has recorded a video summarizing the FAQs and clarifying some of the more ambiguous points to help suppliers factor these early Medicare positions into developing action plans to best serve patients with affected equipment, protect against audits, and minimize cash flow disruptions. You can get a free copy here.  For more information, visit MiraVista website with a special section of resources on the recall issue and watch for continued updates. 

Additionally, the American Academy of Sleep Medicine hosted their second live panel discussion related to the recall on June 25 and the recording and slide deck has been posted online.  Click here for a link to the meeting material. 

Wishing everyone a safe and happy 4th of July weekend!