Providers are fighting to put a stop to Pennsylvania Gov. Ed Rendell's proposed cap on DME for Medicaid patients. The proposal would allow $5,000 per adult per year. Those who would be hit the hardest are chronically ill trauma patients without insurance, according to David Fiorini, executive director of the Pennsylvania Association of Medical Suppliers. “How are they going to be able to deny someone in a traumatic situation a power wheelchair or oxygen if [the patient] exhausts that [$5,000] in nine months?” he questioned. Some providers have said they may pull out of the Medicaid program altogether if they are not reimbursed, while others say they would try to come up with other ways to get the funds, Fiorini added.
Persistence paid off for the Association of Indiana Home Medical Equipment Services, which recently helped to pass legislation requiring DME suppliers to be licensed. “We've tried for three years to get licensure and couldn't get a hearing in an oversight committee,” said Jean Macdonald, AIHMES' director of public policy. But during the Indiana General Assembly's last session, which ended in the spring, a member of the state Attorney General's office mentioned in a meeting about fraud that HME companies weren't licensed, she said. “Suddenly the light went on. [The bill] sailed through without any problems.” The new rule will require suppliers to be licensed by the Indiana State Board of Pharmacy.
