DME Reuse Partnerships with Medicaid

Sara Sack, Ph.D., CCC-SLPDirector, Assistive Technology for KansansResearch Professor, University of KansasMember, National Task Force on AT Reusessack@ku.edu

FYIDurable Medical EquipmentFederal Medicaid regulations cover DME under “Home health services…medical supplies and equipment, and appliances suitable for use in the home….”

State definitions vary,* but most specify:

- Able to withstand repeated use- Serves medical purpose- Not useful in absence of illness or injury- Appropriate for home use

*Check state definition.

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AT reuse benefits

We know that access to DME: Improves health and safetyMinimizes doctor visits and returns to hospitalsReduces or delays assisted living and nursing home placementsEnables some people to return to workMay enable caregivers to continue working

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What is Medicaid?State-administered (with some matching federal funding) health insurance programThird largest source of health insurance after employer-based insurance and Medicare

Eligibility:Low-income families with children People with disabilities

Also provides:Long-term care for the elderly and people with disabilitiesSupplemental coverage for low-income Medicare beneficiaries

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Partnerships between Medicaid and AT Act Reuse Programs

Medicaid programs are showing increasing interest in the reuse of durable medical equipment (DME).

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Checking inventory at the Kansas Equipment Exchange

Factors driving increased interest in reuse from Medicaid programs

Unemployment levels and weak economy add to the number of uninsured and makes increasing numbers eligible for Medicaid.Implementation of the Affordable Care Act will change eligibility and add huge numbers of uninsured adults under 65 to Medicaid.DME will be a major cost. A manufacturer study found that 28% of wheeled mobility equipment and seating was paid by Medicaid.

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Medicaid and DME reuse programs are increasing

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LEGENDActive program

Implementing

Planning stage

Not known

Medicaid and Reuse ProgramsAt least 21 states have considered DMEreuse as part of the Medicaid program.PIOC has consulted with 18 states about Medicaid and reuse in the past five years.Status today (as we know it):

Reuse programs with some Medicaid component: KS, DE, OK, ID, VA, IN, VTJust starting: SD, GA, IAInvestigating: CO, MN, OH, AK, NE, CT, ND, NJ, WA, CA, MA

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Medicaid pays for inventory tracking of all donated DME and the refurbishing of Medicaid-purchased devices that come into the reuse program. (Kansas)

Medicaid-purchased equipment is stickered for return to a reuse program when no longer needed. (Vermont and Virginia)

Different Models for Involvement

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Some Centers for Independent Living provide Medicaid-billable services (e.g., equipment repairs). (Idaho, Paraquad in MO)Proposed Georgia model will provide lightly-used, low-value DME (e.g., manual wheelchairs) to five hospitals in state with most Medicaid patients, to free additional Medicaid funds for complex rehabilitation.

Different Models for Involvement, cont.’

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1. Retention of consumer choice.Reused equipment should not be the first and only option for consumers.

Concerns for Reuse Programs

2. Safe and appropriate reuseMatching beneficiary to the needed device, not “a device” Focus on reuse as an interim solution when delays occur, as a secondary device, or as a transition device

Concerns for reuse programs, cont.’

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3. Maintaining a positive or at least neutral impact on the DME industry and providersMaintain healthy partnerships with vendorsAvoid reducing the supply of equipment available for reuse

Concerns for reuse programs, cont.’

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Administrative issuesLegal/compliance issuesAccreditation requirement?Workplace safetySanitization and consumer safetyEquipment tracking for recalls and alertsTransfer of ownership implicationsWarranty requirement?

Challenges for Partnerships

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Financial How the program is fundedIdentifying which items or categories represent the most significant return on investment (ROI) for MedicaidFraud preventionReimbursement models

Challenges for Partnerships, cont.’

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Program OperationsAgreements, roles, responsibilitiesPrescriptions required for some devices: compliance HIPAA: staff training and compliancePriority holds, wait-listingRepairs: Who does them? Revenue opportunity or a resource issue?

Challenges for Partnerships, cont.’

User ServicesMatching to appropriate (or prescribed) deviceCompliance with state laws that require set-up of some devices by professionals with specific credentialsFollow-upOutcomes measurement

Challenges for Partnerships, cont.’

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How does the Kansas model work?

Collaboration among:Kansas MedicaidDurable medical equipment providersAssistive Technology for Kansans (AT Act)Consumers

This collaboration is specified in contractual agreement.

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Medicaid Eligibility for Reused Devices in Kansas:

1. Medicaid beneficiaries2. Medicaid eligibles3. Those likely to become eligible for Medicaid,

those eligible for limited medical coverage by virtue of limited income and assets, their disability as determined by state Medicaid and their pending application for disability through the Social Security Act.

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Kansas Model

DME VENDORSObtain prior authorization from KEE coordinatorDeliver to customer or return to network

EQUIPMENTMedicaid vs. Donated

CUSTOMERSMedicaid eligibleOthers

AT ACCESS SITE OR KEE PROGRAM COORDINATOR

AT ACCESS SITE STAFFEquipment availabilityCustomer needsMatch and arrange for transfer

NETWORK TEAMS10+ both Disability and Non-disability

Pick up EquipmentSanitizeRoutine maintenance

Deliver EquipmentCustomerVendor for refurbishing

Partnership with Medicaid began in 2003

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Kansas Organizing FactorsTrack, recover, refurbish and reassign DME

Focus on high cost, lightly used devicesExceptions for unmet device requestsNon-DME AT is accepted and refurbished with funds from other sources

Focus on appropriateness and safety

Refurbishing by trained professionals (through DME vendors)Measures to ensure appropriate devices

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Kansas accepts:Augmentative Communication DevicesBath benchesBi-PAPsC-PAPsCanesCommodesCrutchesFeeder seatsFeeding pumpsGait trainers

Health devicesHospital bedsNebulizersPatient liftsQuad canesScootersShower chairsWheelchairs – manualWheelchairs – powerOther items

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How Kansas gets its inventoryReclaiming Medicaid-purchased devices

Medicaid-purchased devices are stickered with requests to return when no longer needed.Device users are tracked.Follow-up calls

In FY 2011, 72% came from general donations

Active efforts to increase awareness of need and encourage donations:

PresentationsPublic service announcementsSubcontractorsNetwork teams

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DME for Medicaid beneficiaries and non-Medicaid clients

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Medicaid may place a priority hold on an item in inventoryDevices are maintained in inventory at Kansas Equipment Exchange (KEE) for 120 daysEquipment not reassigned by KEE after 120 days is distributed to partner organizations throughout the state for reassignment to others in need

Two states PIOC has assisted recently with Medicaid Reuse Programs

OklahomaOklahoma Health Care Authority (Medicaid agency) was legislatively mandated to develop and implement a retrieval DMEprogram.DME program director attended 2009 National Reuse ConferenceABLE Tech responded to Request for Proposal (RFP) and was awarded contract.Oklahoma Durable Medical Equipment Reuse Program was funded December 2011, operational early 2012.

South DakotaOriginated with Medicaid Solutions Workgroup, November 2011Created a workgroupCollaborated with Pass It On Center for Indicators of Quality and lessons learned from other Medicaid partnershipsProgram to be operational ??

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