NEWS & INFORMATION

NCAMES featured in Medicare Bidding Story:

(Link to video on the home page)

News Carolina Channel 14 Story that ran on January 18, 2010

DURHAM -- For many patients, their first stop after being released from the hospital is at a medical supply store. Under some new federal changes though, patients might not be able to pick which store they go to.

“It’s going to eliminate patient access,” said Marcia Ladd, owner of Triangle Aftercare in Durham. “It’s going to restrict patient choice and its going to eliminate probably 80-90 percent of the durable medical equipment businesses in this country.”

Ladd says the idea of forcing businesses to offer equipment for the lowest price and cut out their competitors completely ignores the fact their business is about more than just equipment. “And when you treat an industry that is service driven like our industry as if your bidding for containers, that's stupid,” added Ladd.

The North Carolina Association of Medical Equipment Services agrees with this assessment. They say this will lead to one store providing one piece of equipment, and another, a different one. Their fear is keeping track of which store has what might prove too much for elderly Medicare patients.

“Who do they call?” asked Beth Bowen, NCAMES executive director. “If they can't figure it out who do they call, they go to the hospital.”

Bowen says this is an option that will end up costing the patients and the Medicare program more money. An identical bidding process was tried in 2008, but Congress cut it off because of problems.

“There were providers that got bids in that area ... that had never ever provided oxygen to a patient, and they won an oxygen bid,” said Bowen.

This round of bidding has already taken place in Charlotte, and is expected to go into effect in January of 2011. Asheville, Greensboro and Raleigh will face the same process next year.

Ladd says she understands wanting to save money, but doesn't believe this is the way to do it.

“But to come in and put a program in that is as poorly planned and is as poorly executed as this competitive bidding has been just doesn't make any sense,” said Ladd.

There is a bill before Congress that would eliminate this bidding process, but force providers to cut cost for Medicare patients. Industry members say they prefer this option.

NCAMES will be discussing this issue in their annual winter meeting in Greensboro later this week

New Medicaid Diabetes Contract

November 15, 2009

Dear NCAMES Members:

Information will be coming soon from NC Medicaid (DMA) regarding a new program from Prodigy Diabetes Care who will become the state’s sole source for diabetes care products as of November 15th (Target date). NCAMES has a very strong working relationship with the NC Medicaid office and after fighting off the “single source DME” they were still faced with huge budget shortfalls and had to find a way to save more money other than some line items cuts that we negotiated. NC Medicaid wanted to sole source diabetic supplies but NCAMES continued to communicate our desire to move away from this plan. Once DMA initiated the focus on diabetes testing supply costs, NCAMES continued work with them to make sure the patient and the provider were protected, while at the same time, save money. To our state, the most important outcome is the nearly $4 Million they will save over the two-year contract. It was very important to us to keep your reimbursement virtually the same despite the product and reimbursement model changes (lower reimbursement matched by lower cost of goods). Another element is that the reimbursement and costs are the same for all providers in NC, leveling the playing field in the market. The state sees this program as a win-win-win: Win for the state by saving money, win for the provider to keeps costs/payments nearly the same, and a win for the patients as they receive quality products. Soon, you’ll receive an announcement from the Medicaid office through email/fax with some operational and roll-out details. The goal is to make this transition as seamless as possible for all providers and recipients. We met for the last two days with Medicaid and yesterday with Prodigy Diabetes Care who promotes themselves as a high-tech, high-quality cost effective company based in Charlotte. Since the state decided to go forward with this plan, NCAMES assured them that we will continue to work together to implement this change and support our valuable membership base at the same time. We KNOW you will have questions and I can assure you that Medicaid wants to make this program a success. NCAMES will continue to work with them to ensure a transition that works for all. A few more details: Products affected: Glucose monitor, strips, lancets, lancing device, control solution and syringes.

Roll out plan:

Start date is November 15.
DMA will mail recipients letters the week of Oct 12-16. All Medicaid staff is prepared for influx of calls.
DMA will be sending email blast to physicians and providers. Also you will find this information on DMA’s website.
Prodigy will be sending a team out or calling to educate vendors on the product and where to purchase the product.
Prodigy will be sending a team out to all endocrinologists, diabetic educators, PCP’s, clinics, and providers to educate and provide a demo meter.
Prodigy’s inbound call center will help Medicaid recipients locate a supplier and help with FAQ’s hotline 24/7.
Current existing Medicaid recipients requiring special glucose monitors should apply for Prior Approval immediately so there is no break in service.
DMA and HP Enterprises are aware of possible increase in PA’s for medical necessity strips or other products. HP Enterprises is the new name for EDS.
Prodigy is and has been prepared for the increase in product. They suggest to order TWO weeks prior to the “go live” date.
Prodigy has a special packaging with NDC# on the NC Medicaid product that will need to be put on claims and DMA is working on a special SC modifier for the companies that file with HPCS codes.
Prodigy has three glucose monitors and all are offered to NC Medicaid program: Autocode, Voice, and Pocket. All are blood plasma.
DME providers and Pharmacists will buy Autocode and Pocket meters up front for conversion and Prodigy will rebate full amount for what amounts to a free meter.
Prodigy will not provide any rebate on existing vision impaired recipients to get a Voice meter. Resolution: Prior Approval on existing and normal
DMA procedures on new Medicaid recipients for Voice meter.

Key contacts:
Prodigy Diabetes Care (supply and product questions):
800-366-5901 (main)
www.prodigymeter.com

Recipient Questions:
“careLINK”:
800-662-7030
www.nccarelink.gov

If you have any questions or concerns, please contact NCAMES.

Q&A from Medicaid Diabetes Contract with Prodigy

Comments from DMA:
Pharmacies and DME providers should submit claims according to Medicaid policy. Medicaid recipients are eligible for a meter once every 2 years. If another meter is required, then prior approval may be requested under DME program outside of the limits established. If a Medicaid recipient receives a meter at another pharmacy or DME provider and the current pharmacy or DME provider is unaware of that request then current pharmacy or DME provider will be reimbursed for the meter. However, pharmacies and DME providers should bill for meters according to Medicaid policies and procedures within their individual locations.

Click here for Medicaid Q&A

NCAMES is dedicated to educating stakeholders about the need for patient access to home medical equipment. To that end, we are proactively engaged in a public outreach campaign to share information and statistics on the home medical equipment industry; its impact on North Carolina’s economic development; its role in providing quality care to patients in need; technological innovations; and legislative changes affecting patient access.

Members of the media may contact NCAMES Executive Director Beth Bowen at 919-387-1221 or beth@ncames.org.