1. Georgia Association of Medical Equipment Suppliers
Representing DMEPOS Providers

2. GAMES-Who We Are
Volunteer Association Representing Medical Equipment Suppliers across Georgia
Teresa Tatum-Executive Director
Tyler Riddle-GAMES President; MRS Homecare, Inc.-Vice President
Charlie Barnes IV-GAMES President Elect; Barnes Healthcare Services-CEO
Carl Roan-GAMES Board Member; Soft Touch Medical-Director of Operations
Laura Williard-GAMES Board Member; American Association for Homecare-VP of Payer Relations
Kathleen Yeakey-GAMES Member; Soft Touch Medical-CEO
Alexis Ward-GAMES Member; Numotion-Director of Medicaid Affairs

3. Georgia Medicaid Landscape
1,993,279 Enrollees
70.8% of Population Enrolled in MCO Plan
4 MCO plans in Georgia all have discounts off Medicaid Fee Schedule
60% of Medicaid Population under 18
6th in Country
Georgia Medicaid Landscape

4. CURES Legislation
Will limit the federal contribution for DMEPOS for 255 select E, K, and A codes.
States can still set their own payment rates to ensure access to care.
States will have to complete annual reconciliation by 3/30/2019.
Primary Fee For Service Claims Only
No MCO
No secondary claims
Aggregate expenditure for HCPCS code listing only
Include area patient lives or reconciliation will occur to lowest Medicare allowable in the state
Medicare Rates Unsustainable Due to Flawed Competitive Bidding Program

5. HME Suppliers
Since 2013, 41.8% of suppliers have gone out of business or been purchased due to unsustainable rates.

6. Georgia HME Suppliers
36.8% of unique HME suppliers in Georgia have gone out of business or been purchased since 2013.
37% of DMEPOS locations have closed since 2013.
2 Additional Recent Closures servicing rural areas.

7. Impact of Competitive Bidding on Medicare Beneficiary Access to DME
The survey was completed by 428 patients, 358 case managers, and 266 suppliers.
52% of beneficiaries reported problems.
77.6% of case managers experienced difficulties with timeliness of discharge process due to HME access issues.
89% of case managers report an inability to obtain DME in timely fashion.

8. Dobson Davanzo Cost Study: Proportion of Costs
Cost of goods represents the largest proportion of costs for DMEPOS providers, yet reflects less than 60 percent of costs overall.
-- As reflected in the Federal Register, this amount is the only cost that CMS takes into account when computing its CB pricing.
Indirect and direct costs are those costs that are incurred by providers in the course of patient service.

9. Median Percent of Costs Covered
Study Findings: Median Percent of Costs Covered
All DMEPOS HCPCS included in the survey were reimbursed at a median of 88% of overall cost. The median percent of costs covered for each DMEPOS product category under study is presented below.
DMEPOS Product
Median Percent of Costs Covered
Standard Beds
69.58%
Heavy Duty Beds
90.35%
Liquid Oxygen
86.91%
All Other Oxygen
94.60%
BiPAP with Supplies
91.52%
CPAP with Supplies
67.83%
Walkers
83.88%
Lightweight Wheelchairs with Elevating Leg Rests
82.72%
Lightweight Wheelchairs with Footrests
82.79%
Standard Wheelchairs with Elevating Leg Rests
80.55%
Standard Wheelchairs with Footrests
71.35%
All Products Overall
87.68%

10. Other Information Distinct Populations and Diverse Missions
Community Verses Home Use
Pediatric Population Cost Differentials
Social Security Act Directive
Payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan.

11. Legislative Landscape on Medicare Rates
Legislative precedence for rate changes in Medicare program will create even more unstable reimbursement environment.
Cures Impact to July 1, 2016 fee schedule retroactive
Interim Final Rule-Published in OMB’s Fall Unified Agenda Listing
Retroactive to August 1, 2017 change of Medicare fee schedule to 50/50 blended rates
HR 4229-Protecting HOME Access Act of 2017

12. Issues with SPA set to follow Medicare Rates
Retro fee schedule changes will have to be reprocessed at new allowables
Impacting 1149 codes-not just those in CURES mandate
Allowables already set below Medicare fee schedule will have to be increased
308 codes will require allowable to be increased
158 codes will require allowable to be decreased

13. GAMES Request Freeze rates for 2018 calendar year.
Work with CMS and GAMES to analyze spend verses Medicare allowables.
CMS has agreed to perform initial and quarterly analysis to determine states risk.