State AT Programs Share Medicaid Reuse Initiatives

1. State AT Programs Share Medicaid Reuse Initiatives           Kansas: Sara Sack Oklahoma: Linda Jaco         Vermont: Amber Fulcher   

2. History/What’s Been Done • Kansas-Sara Sack • ATK approached by Medicaid to investigate the design and operation of a cost-neutral DME inventory tracking and recovery program • Started program in 2003 to track and recover high cost, lightly used DME (see card for equipment)

3. History/What’s Been Done • Eligibility: 1) Medicaid beneficiaries, 2) Medicaid eligibles, 3) Those likely to become eligible for Medicaid, those eligible for limited medical coverage by virtue of their limited income and assets, their disability as determined by KDHE and their pending application for disability through the Social Security Act.

4. History/What’s Been Done • 2011-2012 grant year collected 825 devices valued at over $925,000 by Medicaid’s 75% cost reimbursement rate. • Worked with over 30 local DME providers to refurbish the equipment • 711 of the possible 825 devices were matched to Medicaid beneficiaries and Kansans with health conditions

5. History/What’s Been Done • The value of the reassigned equipment was Total number of Kansans who had a medical card and received equipment was 443 and the value of equipment received by Medicaid recipients was $688,340. • Budget for the program was $272,000.

6. History/What’s Been Done • Oklahoma – Linda Jaco • Medicaid legislatively mandated to partner/contract with an organization to establish a reuse program for durable medical equipment that realizes a cost savings and provides access to SoonerCare members and citizens of Oklahoma • ABLE Tech responds to RFP; program started April 2012 to retrieve and/or receive, refurbish, repair and reassign lightly used DME

7. History/What’s Been Done • Eligibility: 1) Medicaid beneficiaries, 2) Medicaid eligibles, 3) Those likely to become eligible for Medicaid, 4) Citizens of Oklahoma. • Application Packet Doctor’s prescription, assessment, if required • Priority given to Medicaid members initial 60 days • Any Oklahoman eligible on day 61 with completed application regardless of income • Transferred to OK Equipment Exchange on day 180

8. History/What’s Been Done • First grant year collected 449 devices valued at over $265,000 by Medicaid’s 75% cost reimbursement rate. • Vendors initially saw program as competition; but, many now asking to partner with program to do DME repairs. • 348 of the possible 449 devices were matched to Medicaid beneficiaries and Oklahomans with health conditions (41/77 counties)

9. History/What’s Been Done • Of the 449 donations, only 3 items were donated by a Medicaid member. • Top 5 largest donations: commodes (35), CPAPs (34), rollators and walkers (83), power scooters (10) and power wheelchairs (23). • Budget for program was $273,000.

10. History/What’s Been Done • Vermont – Amber Fulcher - 2007 Medicaid equipment retrieval project began in conjunction with the Office of Vermont Health Access (OVHA) • Simplified bid was developed in ‘09 by OVHA in conjunction with VATP’s Reuse Project for DME Vendors to bid on refurbishment, sanitization, education, fitting, and delivery services to recipients of retrieved equipment

11. History/What’s Been Done • It was determined by risk management that liability was a concern for OVHA & assumption of ownership became a barrier to DME vendors - It was decided that VT would go forward with other components of Medicaid Equipment Retrieval using a distributed storage model - OVHA: Revamped form; DME vendors placed labels with return instructions on 8 categories of high-end equipment (AAC Devices, Manual & Power chairs, Power operated vehicles, standers, electric beds, shower commode chairs, lifts); toll free number was provided by Dept of Aging & Independent Living

12. History/What’s Been Done • Relationships were established with area non-profits so equipment could be transferred to their ownership following retrieval • Area non-profits transfer equipment to recipients with priority given to individuals who are low income (no formal means testing is used) • Total dollar amount of Equipment Retrieved: 2008-2012 is $300,834 ($48,242 available for transfer at end of 2012)

13. History/What’s Been Done • Recognize need for continued improvement of retrieval and redistribution process and began sourcing leveraged funding to address core areas regarding storage, retrieval, delivery, sanitization, and storage • In process of developing a pilot project with VT Department of Aging and Independent Living • Pilot involves utilizing Statewide DME Vendor Network on a service agreement vs. contract basis to transport, sanitize, and install/set-up equipment

14. Lessons Learned • Kansas-Sara Sack • Relationships with and support from our DME providers is more important than ever before • A good inventory and tracking system is important • Develop and follow strong safety & liability practices • Stick to your program’s values….but remain open to new ideas, i.e. Managed Care

15. Lessons Learned • Oklahoma – Linda Jaco • Very important to build relationships with DME vendors and other statewide stakeholders. • Effective marketing of program so that donations continue to occur. • Inventory/tracking system that works well for both the funder and RSA data collection.

16. Lessons Learned • Vermont – Amber Fulcher - Persistence pays off - Start with sustainability in mind - Be creative in sourcing funding (established with MIG funding) - Build and maintain relationships with DME Vendors - Labeling system encourages continued return of equipment; outreach is needed to maintain

17. Questions