FRANKFORT, Ky. (March 16, 2019)—The Kentucky State Legislature finished work on HB224, with the Kentucky Senate approving the bill on Thursday, with an amendment, by a 36 to 0 vote. The Kentucky House followed with unanimous concurrence for the amended legislation on Thursday night, 89 to 0.
The legislation streamlines durable medical equipment (DME) regulations and reimbursement policy for Managed Care Organizations (MCOs) supporting the state’s Medicaid program in several ways:
- Ensures that MCOs reimburse DME suppliers by at least 90 percent of the rate set by the Kentucky Medicaid program.
- Requires that specialty items not listed on current fee schedule be reimbursed at the manufacturer’s suggested retail price minus 18 percent or at invoice cost plus 20 percent where there is no MSRP, and eliminates the ability for the MCO plan to take any discounts from these codes.
- Requires that MCOs provide coverage for the same HCPCS codes and the same quantities of medical supplies, equipment, or services as are established on the Kentucky Medicaid program DME fee schedule or Kentucky Medicaid medical policy.
“The provisions in HB224 will go a long way towards helping reduce the cuts providers received last year due to the Cures legislation,” notes Laura Williard, vice president of payer relations for AAHomecare. “This bill will put $7 million dollars back into the pockets of Kentucky DME providers so they can continue to provide excellent care and keep patients in their homes. This also gives us momentum to build upon in working with other states to establish rate floors for DME.”
“This legislation is terrific news for Medicaid beneficiaries and caregivers in Kentucky who rely on home medical equipment,” said Teresa Aldridge, executive director of the Kentucky Medical Equipment Suppliers Association (KMESA). “By stabilizing Medicaid reimbursement rates and clarifying regulatory policy, Kentucky lawmakers are providing a more sustainable business environment for DME suppliers who serve Medicaid beneficiaries, many of whom face profound health challenges.”
“The overwhelming support these bills received is a testament to the effort and effectiveness of HB224’s principal sponsors, Rep. Kim Moser and Sen. Ralph Alvarado,” added Aldridge. “These leaders understand the important role home medical equipment plays in allowing patients to stay in their homes and communities while reducing the need for hospitalizations, nursing home stays, and other more costly clinical interventions.”
“I want to thank AAHomecare’s Laura Williard for lending her expertise and negotiating skills to this effort,” said Aldridge. “It would have been very difficult to accomplish what we were able to do without her. I also appreciate the persistent advocacy work by members of the KMESA legislative committee who helped educate our state legislators: Carolyn Basford, David Chestnut, Thad Connally, Mike Downing, John Gallagher, and Jim Graham.”
“Eric Landrum, a Medicaid recipient, was our rock star as he willingly testified before the House and Senate Committees,” added Aldridge. “Eric has been confined to a rehab motorized wheelchair for 25 years and his testimony before Representatives and Senators was very personal; he did an outstanding job on our behalf. Our effort goes to show we are able to accomplish great things when everyone works together. I am very proud of our association and honored to serve as its executive director.”
“I feel that HB224 is a trifecta win for patients, providers, and even payers in Kentucky,” said Carolyn Basford, RRT, quality and compliance manager for RSVP Homecare. “If we as DME providers, are treated fairly and consistently by the MCOs, we can continue to provide great care and service to our patients which obviously keeps them in their homes, thereby reducing readmissions.“
The bill now heads to Kentucky Governor Matt Bevin for his approval.
Visit kmesa.wildapricot.org for more information.
