ATLANTA--While most home medical equipment providers have been consumed this year with such national issues as competitive bidding and accreditation, there have been plenty of problems percolating at the state level.

A HomeCare Monday poll of state associations shows providers grappling with everything from budget cuts and slow-as-molasses payments to sales tax on HME. Here is a roundup of issues from responding associations around the country:

Arizona--Arizona providers' frustration levels have risen over the reluctance of the Arizona Healthcare Cost Containment System, Arizona's Medicaid, to allow managed care plans to contract with more durable medical equipment providers, according to the Arizona Medical Equipment Suppliers Association.

“We are constantly hearing about customers that are waiting three to six months for new or serviced equipment, but yet the plans are reluctant to sign contracts with any more DME vendors,” said Mark Farmer of Southwest Mobility in Mesa, Ariz., and association president. “They say that their needs are currently taken care of. Yet the customers are the ones suffering from lack of service.

“We feel and many in the state association feel that the AHCCCS program needs to better serve their beneficiaries by allowing more providers to participate in their programs,” Farmer added.

California--With no state budget for the fiscal year that started July 1, a 10 percent cut in Medi-Cal reimbursement and a host of other issues involving the state Medicaid program, California HME providers are feeling pretty beleaguered these days, according to Bob Achermann, executive director of the California Association of Medical Product Suppliers.

Last week, California's legislature was still at an impasse over the budget, and the fund that feeds Medicaid was drying up. The state is already in trouble with a $17 billion budget shortfall; legislators earlier decreed a 10 percent-across-the-board cut that took effect July 1.

So providers are waiting for their Medi-Cal money, and less of it. The only bright spot showed up last week when a U.S. District Court judge in Los Angeles ruled against implementation of the 10 percent Medi-Cal cut, saying it would compromise the quality of medical care.

“We don't know if it will be retroactive … but it is very helpful,” said Achermann. He said he is confident the cut will eventually be eliminated. However, that may not happen before damage is done to both providers and beneficiaries.

“Whatever happens, I think the state's fiscal budget is going to be pretty gloomy for awhile,” he said.

Just at press deadline, Gov. Arnold Schwarznegger's office announced that he planned to appeal the ruling.

Colorado--The Colorado Association of Medical Equipment Services is largely concentrating on national issues, according to Jody R. Wright, president, Rocky Mountain Medical Equipment, Sheridan, Colo., and chairman of the Colorado Medicaid DME Advisory board.

Wright said those issues are: “What to do about the 9.5 percent cut coming in January; what is CMS going to do about oxygen in January; and, of course, competitive bidding.”

Florida--Heather Allan, executive director of the Florida Association of Medical Equipment Services, said the Agency for Healthcare Administration, which is the parent agency for the Florida Medicaid program, issued a proposed rule last week allowing Medicaid to do a single-source provider competitive bid for unspecified equipment. At this time, Allan said FAMES is unable to determine what equipment Medicaid is targeting with the rule, but “we are keeping an eye on it.”

Georgia--Speaking for the Georgia Association of Medical Equipment Services, provider Scott Lloyd of Extrakare in Norcross, Ga., said the industry celebrated a victory earlier this year when the state legislature voted to exempt all prescription DMEPOS from sales tax. While equipment that was paid for with federal funds was already exempt, now all items of DME as defined in the Social Security Act are exempt even for payments made by a third party, such as private insurance plans. ”The advantage to beneficiaries is that they will not be personally responsible for sales tax on items reimbursed by private insurance,” Lloyd said.

There was another victory when Georgia Medicaid, which had established a mandatory accreditation deadline prior to Medicare's mandatory accreditation deadline of Sept. 30, 2009, was postponed to coincide with the Medicare deadline.

But GAMES has other issues. Lloyd said the state's recent decision to replace Blue Cross/Blue Shield with Cigna as the insurance for Georgia's State Employee Health Benefit Plans is causing a stir. According to Lloyd, Cigna has an exclusive with Apria Healthcare.

”It's going to reduce the patient's choice for retirees' medical equipment if they're on the Cigna plan,” he said.