Colorado ODs get long overdue Medicaid pay boost

For the first time in four decades, Colorado optometrists providing eye exams to Medicaid patients will see an increase in their reimbursement. 

"We always went at this from a patient-centered care place."

A budget bill approved by the state legislature and signed by Gov. John Hickenlooper (D) calls for Medicaid providers to get paid at 80 percent of Medicare, starting on July 1. 

Before the bill's passage, Medicaid had been paying ODs approximately $26 to $27 for an eye exam. "We hadn't had an increase in 40 years," says Deanna Alexander, O.D., legislative chair of the Colorado Optometric Association and chair of the AOA's State Government Relations Committee.

An OD since 1987, Dr. Alexander recalls that she got paid $28 for exams when she first started her practice, meaning reimbursement has actually gone down. Under the new pay increase, payments will average about $90 to $94, she says. 

The increase specifically applies to eight vision codes for Medicaid, all of which relate to comprehensive eye exams.

"Some of the codes are for new patients, some are for established patients and there are some codes for intermediate eye exams that are not used very frequently," Dr. Alexander says. 

Optometry appealed to state regulators
Working with state administration officials to get this rate increase was key. Not many ODs see Medicaid patients, mainly because reimbursement has been so low, says Kathi Williams, COA's executive director. 

Access in the state is critical, however. Colorado is one of the states that decided to expand Medicaid eligibility to 133 percent of the federal poverty level under the Affordable Care Act. 

"We always went at this from a patient-centered care place," Williams says. "That is, we got a lot of patients in Colorado who were not getting served at all or on a very infrequent basis. So, in order to inspire more doctors and increase their ability to see more Medicaid patients, we asked for an increase."

This was accomplished through meetings with the Colorado Department of Health Care Policy and Financing (HCPF), in addition to member letters, asking regulators to boost Medicaid rates to 80 percent of Medicare. HCPF is the department in Colorado that manages Medicaid.

"Three of our doctors of optometry and I paid a visit to the cabinet member and two staff members at HCPF," Williams says. "We showed them the difference between what Medicare was paying and what Medicaid was paying." The AOA did its part by providing some advice on strategy through its State Government Relations Committee and staff. 

COA appealed to regulators by explaining that the vision piece was just a small part of Medicaid. "We said: Look at the big impact you can make for such a small investment," Williams says. "I think that's one of the reasons why we were able to get 80 percent of Medicare," as opposed to a lower percentage like 70 percent, she adds.

The pay boost will go a long way toward improving access, Dr. Alexander says. She reports that patients she's seen in the past are coming back to her office with new Medicaid coverage through the state's exchange. Enrollment in the program is going to increase, she adds. 

May 5, 2014

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