Massachusetts Medicaid Public Hearing

Payment Rates: 101 CMR 334.00: Prostheses, Prosthetic Devices, and Orthotic Devices

[Seal 2]The Commonwealth of Massachusetts
Executive Office of Health and Human Services
One Ashburton Place, Room 1109
Boston, Massachusetts 02108
[Tel: (617) 573-1600 Fax: (617) 573-1891 www.mass.gov/eohhs]
[CHARLES D. BAKER Governor KARYN E. POLITO Lieutenant Governor MARYLOU SUDDERS Secretary]

NOTICE OF PUBLIC HEARING

Pursuant to the provisions of M.G.L. c. 118E and in accordance with M.G.L. c.30A, the Executive Office of Health and Human Services (EOHHS) will hold a public hearing on Friday, August 17, 2018 at 2:30 p.m. in the First Floor Conference room, 100 Hancock Street, Quincy, MA relative to the adoption of:

101 CMR 334.00: Prostheses, Prosthetic Devices, and Orthotic Devices

The proposed regulation 101 CMR 334.00 amends and updates the payment rates for Orthotic and Prosthetic services provided to publicly aided individuals by governmental units. Amendments for 101 CMR 334.00 are proposed in accordance with M.G.L. Chapter 118E, sections 13C and 13D, which require the Executive Office of Health and Human Services (EOHHS) to establish and periodically review the rates to be paid by governmental units for non-institutional health care services, including Orthotic and Prosthetic services provided under the MassHealth program.

The proposed amendments:

(1) codify and clarify existing policy including updates to definitions and updates implemented through the Administrative Bulletin (AB) process following the prior regulation revision through March, 2018 including annual Healthcare Common Procedure Coding System (HCPCS) coding updates;

(2) generally rebase rates to 2017 Medicare rates;

(3) update components of the pricing methodology and rates for the three tiers of products (custom fabricated, prefabricated/custom fitted, and off-the-shelf) while continuing the practice of setting the percentage of Medicare fees based on product complexity, with the highest percentage of Medicare fees for the most complex (custom fabricated) services and reduce current percentages for less complex services, by 12.713%, as follows:

a. Maintain 93.47% of Medicare for custom fabricated;

b. Adjust from 88.47% to 75.76% for prefabricated/custom fitted;

c. Adjust from 83.47% to 70.76% for off-the-shelf.

(4) maintain the existing individual consideration methodology for items without a Medicare rate, with pricing based on product complexity.

The proposed effective date of the regulations is November 16, 2018.

EOHHS is proposing these changes and amendments to ensure payments are consistent with efficiency, economy, and quality of care. EOHHS anticipates that annual aggregate MassHealth expenditures will decrease by approximately $4.24 as a result of these amendments. There is no anticipated fiscal impact on cities and towns. The amendments are not anticipated to impose new costs on small businesses, and any impact on small business providers will vary based on the volume of services provided.

Individuals who notify EOHHS of their intent to testify at the hearing will be afforded an earlier opportunity to speak. Speakers may notify EOHHS of their intention to testify at the hearing by registering online at www.mass.gov/service-details/executive-office-of-health-and-human-services-public-hearings. Individuals may also submit written testimony by emailing [email protected]. Please submit electronic testimony as an attached Word document or as text within the body of the email with name of the regulation in the subject line. All submissions must include the sender’s full name, mailing address, and organization or affiliation, if any. Individuals who are unable to submit testimony by email should mail written testimony to EOHHS, c/o D. Briggs, 100 Hancock Street, 6th Floor, Quincy, MA 02171. Written testimony must be submitted by 5:00 p.m. on August 17, 2018. EOHHS specifically invites comments as to how the amendments may impact beneficiary access to care.

All persons desiring to review the current draft of the proposed actions may go to

www.mass.gov/service-details/executive-office-of-health-and-human-services-public-hearings or request a copy in writing or in person from MassHealth Publications, 100 Hancock St.,6th floor, Quincy, MA 02171.

Special accommodation requests may be directed to the Disability Accommodations Ombudsman by email at [email protected] or phone at 617-847-3468, (TTY: 617-847-3788 for people who are deaf, hard of hearing, or speech disabled). Please allow two weeks to schedule sign language interpreters.

EOHHS may adopt a revised version of the proposed actions taking into account relevant comments and any other practical alternatives that come to its attention.

In case of inclement weather or other emergency, hearing cancellation announcements will be posted on the MassHealth website at www.mass.gov/masshealth.

Paula Rogerson-Doherty
Business & Administrative Manager
Rogerson Orthotics & Prosthetics
P:(617) 268-1135
F(617) 269-3373
www.rogersonoandp.com

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