To Sen. Dave Syverson (R-Rockford), the government has no business price-fixing when it comes to vendors dealing with managed care organizations (MCOs).
SB2262, sponsored by Sen. David Koehler (D-Peoria), would amend the public aid code that requires Medicaid MCOs to pay at least the same amount the Department of Health and Family Services pays to services for durable medical equipment providers, a line Syverson said should not be crossed by government officials at a Senate Human Services Committee hearing on Feb. 20.
“This is happening even more so in the non-Medicaid population and general population where medical networks have gotten skinnier and skinnier and contracts have gotten tighter and tighter, and providers have asked for lower rates then what they have before,” Syverson said. "Vendors have a right to say, 'No we won’t accept that,' and just not be in the contract opposed to us trying to dictate what the prices would be."
Illinois State Sen. Dave Syverson (R-Rockford)
Philippe Largent, Great Lakes government relations consultant for Great Lakes Home Medical Services Association, and Dan Heckman, owner of Heckman Healthcare, which provides oxygen concentrators, respiratory therapy, nebulizers and other major medical supplies, said they want the right to reject the terms of 60 percent fee reductions from unreasonable MCO providers for equipment they provide to medically fragile children.
“If the provider can’t service at that rate and the family has been dealing with that provider for years, that’s a pretty bad experience for the patient and the family,” Heckman said.
Syverson didn’t budge.
“If we do that for you, then we would obviously have to do that for everybody,” Syverson said. “We would have to make every vendor pay at that Medicaid rate for all services.”
Largent said a 60 percent rate cut as proposed by some vendors is questionable and assumed the Department of Health and Family Services (DHFS) would step in to assure patients safety due to the disruption of care inevitably occurring.
“To our knowledge, those discussions did not happen,” Largent said. “The department was not aware of the reduction until Great Lakes informed them.”
Syverson said whether or not DHFS knew doesn't matter.
“If we set the bottom price saying you can’t pay less than the Medicaid rate, then are we going to set the top rate, too?” Syverson said. “Right now, it is a free market.”
Largent said though true, at end of the day the patient will suffer.
“This is especially true for medically fragile kids, and according to Great Lakes, the significant deviant from the rates should have prompted by the DHFS," Largent added.
Sen. Syverson said “bottom-line” micromanaging against unfair MCO’s could be a big mistake, and he fears going down the slope of fixed pricing and taking away the ability for negotiating rates will not fair well.
Koehler asked that the legislation move out of committee and will continue to work.
SB2262 passed 6-3 and will move on.
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