ORLANDO, Fla., CARY, N.C. and DALLAS — Working vigilantly to defeat Medicaid competitive bidding proposals, three state durable medical equipment associations have achieved significant success during recent weeks.

In Florida, where the state's Medicaid arm already has awarded competitive bidding contracts for oxygen services and hospital beds, DME advocates are optimistic that a judge's ruling could stop competitive bidding in its tracks. In a preliminary ruling issued June 26, a state judge suggested that Florida's Agency for Health Care Administration had overstepped its bounds in implementing competitive bidding without prior approval from the federal government.

At the final hearing in a case that the Florida Association of Medical Equipment Services brought against AHCA, the agency could not explain why it had failed to gain federal approval for a competitive bidding program that awards only one DME contract per district, the judge said.

Despite these positive signs, the fate of Medicaid competitive bidding in Florida still is unclear, according to Joan Cross, president of FAMES. The judge will not issue a final decision until sometime this month, and AHCA seems committed to implementing the program.

However, in a July 8 letter to Florida's Medicaid DME providers, AHCA admitted that several protests — filed by DME providers who did not win Medicaid contracts — could slow the implementation process. “In these seven areas [where providers are protesting contract awards], there will be no change in the method of operation until each protest is resolved,” said Bob Sharpe, deputy secretary for AHCA's Medicaid program. “This probably means that contracts will begin at different times in different areas.”

In North Carolina, where state senators included Medicaid competitive bidding for DME in the 2002-03 budget, the state's DME association so far has lobbied successfully to keep competitive bidding provisions out of the state House's budget.

“We were able to convince key appropriation committee members in the House that competitive bidding wasn't the best thing for North Carolina,” said Clark Robichaux, vice president of the North Carolina Association for Medical Equipment Services. “We feel we've taken care of competitive bidding language in the [House's] budget bill.”

While NCAMES is “cautiously optimistic” that North Carolina's Medicaid arm will be forced to find other avenues — besides competitive bidding — to achieve budget savings, Robichaux says the association is not taking any chances.

“We have submitted a proposal that would include a reduction in the fee schedule [for DME] to meet the immediate needs of the budget,” Robichaux explained. “We also have given [the state's Medicaid agency] some recommendations on how to weed out non-serious providers.”

Three months ago, Texas became the third state to jump on the Medicaid competitive bidding bandwagon when it issued a draft “request for proposals” for Medicaid DME.

However, after receiving comments on the draft RFP and meeting with representatives from the Dallas-based Medical Equipment Suppliers Association, Texas' Health and Human Services Commission decided to withdraw the proposal, according to the Texas HHSC Web site.

“Public comments received by HHSC on the draft DME RFP raised sufficiently significant questions about whether the RFP would achieve the desired results that HHSC is withdrawing the draft RFP,” the commission said.

Nonetheless, “HHSC reserves the option to put forward another draft competitive pricing mechanism later this summer if it determines that such an approach is supported by the commission's further analysis. Any such draft will be subject to public comment,” the commission added.

Like NCAMES, MESA is working with Texas' Medicaid arm to determine other ways to cut costs. “All providers will feel some of the cuts,” MESA wrote in a letter to Texas Medicaid providers last month. “It is imperative that the recommendations for those cuts come from us, not from someone who does not have hands-on experience with the beneficiaries.”

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