State considers reused medical equipment

Medicaid patients in Alaska may soon be able to get recycled wheelchairs and walkers.

The Alaska State Legislature and the Alaska Department of Health and Social Services are working on amending Medicaid regulations to allow reimbursement for reused durable medical items rather than having patients purchase new ones each time. Legislators have introduced bills in both the Senate and the House of Representatives that authorize Alaska’s Medicaid program to reimburse for used durable medical equipment — wheelchairs, walkers and any other equipment that is made for more than one use. The measure passed through the House of Representatives in May, and a second version is working its way through the Senate.

In the past, Medicaid could only reimburse for new equipment — if a patient bought a used wheelchair, Medicaid did not cover it. The Department of Health and Social Services is working on a draft of new regulations to allow a lower reimbursement rate for used medical equipment. Patients likely won’t be financially affected. Because there is no copay on the durable medical equipment, the cost savings are largely for the Medicaid program.

The measure is a formalization of a recommendation for the department to revise its regulations, said Erin Narus, the program manager for pharmacy and ancillary services at the Department of Health and Social Services.

“Under Medicaid, the durable medical equipment are items like your wheelchairs that would be used by the individual or home in their community setting,” Narus said. “Both of them would have to meet the same standards, that they would have the same life and ensuring that there’s no defect.”

Sen. Peter Micciche said at his town hall meeting on Dec. 2 that he plans to include the bill in his legislative agenda in the upcoming January session. Micciche is one of eight cosponsors on the Senate’s version of the bill, which was initially introduced last March.

“(This is) part of bringing the cost down of Medicaid,” Micciche said. “Before, in our state, you couldn’t reuse durable medical equipment. If you had a very high-priced wheelchair and the person didn’t need it anymore, they would have to purchase a new one for that client.”

Many other states have instituted similar programs. North Dakota, Kansas, New Jersey and others have been running the programs for years. Many claim that this provides cost savings for the Medicaid program, as the amount paid out for the reused medical equipment is lower.

The Pass It On Center at the Georgia Institute of Technology, which studied the reuse programs, found that the program in Kansas returned $3.03 for every dollar invested in the program and reassigned $839, 201 of durable medical equipment not purchased by Medicaid.

Sen. Bill Stolze, one of the bill’s sponsors in the Alaska Senate, wrote in a sponsor’s statement that the program is one additional way for the state to cut costs.

“Allowing for the establishment of a durable medical equipment re-use program is one more way the state can reduce costs and help alleviate the burden of our fiscal uncertainty,” Stolze wrote.

In states that have reuse programs, used equipment is collected and refurbished and then resold. Traditionally, independent organizations such as independent living centers and faith-based organizations have collected the equipment, according to the Pass It On Center.

The durable medical equipment provider is required to ensure that the used equipment is in good condition and that everything works like new. In addition to savings, Narus said the program could provide equipment to patients sooner than if it must be shipped in new from elsewhere.

“I think it might actually provide some additional opportunities for the patients,” Narus said. “If there was a used product that was readily available in the state versus something that would have to be new and shipped in, there might be a shortened time frame within which they would be able to obtain that.”

However, Michelle Morrelle, the owner of home medical equipment distributor Alaskare Home Medical Equipment in Soldotna, was wary of more changes. There have been a number of changes with Medicare already, which is federally administered, all leading to lower reimbursement rates.

“Here’s another change, and it’s cumulative here, as far as all the changes,” Morrelle said. “Obviously, our cost on things hasn’t gone down at all. It’s going up. A 25 percent reduction is pretty big with Medicare.”

Morrelle also worried about the requirement for distributors to ensure that the product works perfectly. When distributors buy a new wheelchair or walker, it typically comes with a warranty in case something goes wrong, she said. With used equipment, there’s no factory to ship it out to when something breaks.

“With Medicare, if there’s anything wrong with the equipment, we’re obligated to fix it in the warranty period,” Morrelle said. “If something is used, it’s not under warranty. Medicare requires up to 13 months of warranty.”

The businesses will likely have to review expenses, and that may come at the cost of more choice for patients, she said.

“It may be, ‘You don’t have a choice, this is what you get,’” Morrelle said. “It may be kind of the cheapest thing out there. (Expenses are) obviously something we’re going to have to look at.”


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