2010 Session

Budget Amendments - SB30 (Member Request)

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Chief Patron: Hanger
Medicaid DME Reimbursement Changes (language only)

Item 297 #14s

Item 297 #14s

Health And Human Resources
Medical Assistance Services, Department of

Page 209 line 4, after "Committees", insert:
"Notwithstanding the findings and suggestions contained therein, the fee schedule rate reduction for incontinence supplies shall not exceed the 10 percent reduction recommended in this report."
Page 209, line 14, strike "have the authority to".
page 209, line 15, strike "modify", and insert:
"perform an impact analysis on the potential effects of instituting a competitive bidding requirement for".
Page 209, line 15, strike "based on", and insert:
". DMAS shall solicit input from, and consider the views expressed by, patient advocacy groups and Virginia-based providers, and the analysis shall include consideration of the following:  (i) impact on quality of patient care, (ii) impact on product accessibility by Medicaid recipients, (iii) the likelihood that competitive bidding would result in actual savings, (iv) the expense of designing conducting and properly managing the competitive bidding process, and (v) the impact on Virginia companies and employers.  This analysis shall include a review of other state’s experience with the imposition of competitive bidding requirements for the reimbursement of Durable Medical Equipment for incontinence supplies.  DMAS shall, prior to implementing a competitive bidding process for the reimbursement of Durable Medical Equipment for incontinence supplies, report to the Chairmen of the House Appropriations and Senate Finance Committees the findings and conclusions resulting from such analysis and obtain budget authority for undertaking a competitive bidding process. Any such competitive bidding process shall be subject to approval by the Centers for Medicare and Medicaid Services (CMS)."
Page 209, strike lines 16 through 18.
Page 209, strike lines 19 through 23, and insert:
"WWW.  The Department of Medical Assistance Services (DMAS) shall maintain current quantity limits for incontinence supplies that may be furnished without requiring a prior authorization until DMAS (i) conducts further analysis of the potential effects upon patients and providers of modifying such limits, and (ii) reports the findings of this analysis to the Chairmen of the House Appropriations and Senate Finance Committees."
XXX.  The Department of Medical Assistance Services (DMAS) shall, to assist in the prevention of fraud, waste and abuse, require all Durable Medical Equipment suppliers enrolled in the Virginia Medicaid program to (i) be certified Medicare DMEPOS Suppliers which includes accreditation by a CMS-approved accreditation organization, adherence to all other Medicare DMEPOS Supplier Standards and implementation of a corporate compliance program, and (ii) have a physical presence in the Commonwealth, as is currently required in some other states."

(This amendment modifies language in the introduced budget which limits the amount of savings to be gained from reducing reimbursement by 10 percent for Durable Medical Equipment (DME). Language also requires the department to perform an impact analysis of beginning a competitive bidding requirement for reimbursement of DME for incontinence supplies and work with interested parties to solicit input along with other criteria in determining whether to go forward with this proposal. Language is modified to lift a limit on quantity limits and require the department to maintain current limits without prior authorization and conduct further analysis of the effect of imposing limits on these supplies. Additional requirements are added regarding requirements for DME suppliers enrolled as Virginia Medicaid providers to be certified and have a physical presence in Virginia.)