August 2016 NYS Medicaid Incontinence Supply Management Program - PowerPoint Presentation

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August 2016

NYS Medicaid Incontinence Supply Management ProgramSlide2

NYS Medicaid Incontinence Supply Management Program

History

The 2013-2014 State budget adopted MRT recommendations, including an incontinence supply initiativeSocial Services Law Section § 365-a (2)(g)(v) authorizes the ProgramThis initiative seeks to improve the quality of incontinence products provided to all Medicaid members by establishing minimum quality standards for adult and youth size diapers and reducing costs for incontinence products while maintaining the existing provider (Durable Medical Equipment and Pharmacy) network

August 2016

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NYS Medicaid Incontinence Supply Management ProgramCurrent Coverage, Utilization, and Management

Incontinence supplies are covered by Medicaid for ages three (3) and above, and include medically necessary reusable and disposable diapers, liners, and

underpads

Providers of incontinence products are nearly all for-profit enterprises and are reimbursed for these products on a per unit basis. In FFS, each billing (HCPCS) code has an assigned per unit Maximum Reimbursable Amount (MRA) Providers are reimbursed up to, but not exceeding the MRA for each HCPCS codeAugust 2016Slide4

NYS Medicaid Incontinence Supply Management ProgramCurrent Coverage, Utilization, and Management

Individual

and chain providers currently purchase incontinence related products through a variety of sources, with each provider paying varying unit rates for the same or similar

productIn FFS, enrolled providers are reimbursed an established Maximum Reimbursable Amount (MRA) regardless of their actual acquisition cost by invoiceIn MMC and MLTC, providers are reimbursed in accordance with the plan’s contractAugust 2016Slide5

Table 1. Baseline Medicaid Utilization for Fee for Service and Managed Care Populations – 2013 Statistics

HCPCS

Code

Brief DescriptionAnnual Spending (in millions)

Unique

Members

Units

per year

A4554

Disposable

Underpads

22.1383,91586,530,471T4521Disposable Adult Small Diaper2.227,7375,035,360T4522Disposable Adult Medium Diaper10.2834,66821,614,415T4523Disposable Adult Large Diaper18.5445,32429,542,342T4524Disposable Adult Extra Large Diaper10.9526,46716,477,462T4529Disposable Pediatric Small/Medium Diaper.0321895,548T4530Disposable Pediatric Large Diaper.431,4561,300,799T4533Disposable Youth Diaper1.865,4425,191,114T4535Disposable liners/pads9.1555,13236,363,469T4537Reusable Underpad, Bed Size4.6529,099353,321T4539Reusable Diaper, any size4.8727,257575,855T4540Reusable Underpad, Chair size1.0812,016155,840T4543Disposable Bariatric Diaper (waist/hip >62”)1.041,615879,841

August 2016

A unit refers to an individual item (e.g.: 1 diaper = 1 unit)Slide6

NYS Medicaid Incontinence Supply Management Program

Minimum Quality Standards for Incontinence Products

Beginning September 1, 2016, adult and youth sized diapers dispensed to all Medicaid members must meet the following minimum product specifications established by the Department of Health:

No plastic (non-breathable) backed productsRewet rate of <2.0 gRate of Acquisition (ROA) of <60 secondsRetention capacity of >250 gPresence of breathable zones with a minimum value of >100 cubic feet per minute (cfm)

Presence of a closure system which allows for multiple fastening and unfastening occurrences

These minimum standards apply to all products dispensed (Managed Care or Fee for Service)

August 2016Slide7

NYS Medicaid Incontinence Supply Management Program

Quality Standards – FFS and Managed Care

The quality standards for incontinence products will apply to all FFS, MMC, and MLTC members. MMC and MLTC plans will be required to ensure they offer products provided to members that meet the established Medicaid FFS minimum standards

Plans can choose to continue with their own contracts as long as the products dispensed meet the established quality standardsAugust 2016Slide8

NYS Medicaid Incontinence Supply Management Program

Preferred Vendor Contract

The NYS Department of Health has awarded a contract to Twin Med, LLC to become the preferred vendor of incontinence products for Medicaid providers

Medicaid providers who purchase incontinence supplies from Twin Med will receive competitive pricing as defined by the contract and a defined formulary that meets the new minimum product specificationsAugust 2016Slide9

NYS Medicaid Incontinence Supply Management Program

Preferred Vendor Contract

Twin Med, LLC will ensure that the Providers will receive all deliveries within three (3) business days of the date the order was placed.

They will have adequate inventory to ensure all deliveries are received within three (3) business daysTwin Med will not require a minimum unit order quantity. No additional delivery fees will be charged to the Medicaid providers based on order sizeIt will not be mandatory for plans or Medicaid providers to purchase from the contracted preferred wholesale distributor

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NYS Medicaid Incontinence Supply Management Program

Verification of Minimum Quality Standards

If products are purchased from Twin Med under the Program:

An enrolled Medicaid provider does not have to verify incontinence product quality standards Documentation demonstrating that the products meet the minimum quality standards will be maintained by Twin Med, LLC and available on requestAugust 2016Slide11

NYS Medicaid Incontinence Supply Management Program

Verification of Minimum Quality Standards

If products are

NOT purchased from Twin Med under the Program:The Medicaid providers will be responsible for verification that products dispensed meet the Department’s minimum quality standardsVerification must be through an independent testing laboratory facility

The Provider is responsible for keeping all verification documentation onsite

Documentation must be maintained for at least 6 years from the date of the order and produced to the NYS Department of Health or the Office of the Medicaid Inspector General when requested

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NYS Medicaid Incontinence Supply Management Program

Provider Ordering and Customer Support

Providers

will be able to place orders with Twin Med 24 hours per day, seven (7) days per week either online, via fax, or through a dedicated toll free phone lineTwin Med’s customer service support will provide live call support that is available during normal business hours of 9am to 5pm ETTwin Med will make product options, sizing/fit and minimum quality standards ratings available to Medicaid providers

A

complaint resolution process will be in place to address unanswered or unresolved questions and concerns. Email responses to the enrolled provider will be returned within two (2) business

days

August 2016Slide13

NYS Medicaid Incontinence Supply Management Program

Twin Med Formulary and Pricing

Pricing and the incontinence formulary may be found at www.twinmedny.com or www.emedny.org

The Twin Med formulary will be updated periodically to reflect current products that are offeredCurrent pricing is in effect until 11/15/2020Products may be ordered by internet, telephone or FAXAll Medicaid providers will have access to Department negotiated pricingPricing is based in HCPCS product code and is applied to all products in the published formulary that

meet the

description

Maximum

Reimbursable

Amounts (MRA) will be

adjusted in the future

to reflect the cost savings based on contract pricing

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NYS Medicaid Incontinence Supply Management Program

Products Offered

Twin Med will offer a minimum of two (2) products within each of the HCPCS code groups. All products will be guaranteed against defect. Any products found to be defective will be replaced at no cost to the network

providerTwin Med will offer products in a full range of sizes representing all defined HCPCS code categoriesTwin Med will make the product samples available to providers upon their request, free of charge. Sample products are meant to be used as representative of sizing and are NOT meant to be given to the member

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NYS Medicaid Incontinence Supply Management ProgramPricing

(HCPCS codes in BOLD are subject to minimum quality standards)

HCPCS CODE

BRIEF DESCRIPTIONCONTRACTED PRICEA4554

Disposable

Underpads

$0.15

T4521

Disposable

Adult Small Diaper

$0.25

T4522Disposable Adult Medium Diaper$0.25T4523Disposable Adult Large Diaper$0.34T4524Disposable Adult Extra Large Diaper$0.41T4529Disposable Pediatric Small/Medium Diaper$0.16T4530Disposable Pediatric Large Diaper$0.28T4533Disposable Youth Diaper$0.32T4535Disposable liners/pads$0.15T4537Reusable Underpad, Bed Size$7.00T4539Reusable Diaper, any size$6.00T4540Reusable Underpad, Chair size$3.95T4543Disposable Bariatric Diaper (waist/hip >62”)$0.65August 2016Slide16

NYS Medicaid Incontinence Supply Management Program

Twin Med Formulary as of 8/1/2016

HCPCS

Products

T4521

First Quality Prevail Briefs, Small, (20”-31”) 96/CS

Covidien Quilted Briefs, Small, (20”-31”) 96/CS

T4522

First Quality Procare Brief, Medium, (34”-44”) 96/CS

Nu-Fit Briefs Medium, (34”-44”) 96/CS

 First Quality Procare Underwear, Medium (34”-46”) 80/CS First Quality Procare Plus Underwear, Medium, (34”-46”) 100/CS Covidien Quilted Briefs, Medium, (34”-44”), 100/CS 

Covidien Surecare Underwear, Medium, (34”-48”) 80/CS

T4523

First Quality Procare Briefs, Large, (45”-58”) 72/CS

First Quality Nu-Fit Briefs, Large, (45”-58”) 72/CS

First Quality Procare Underwear, Large, (46”-58”) 72/CS

First Quality Procare Plus Underwear, Large, (46”-58”)

Covidien Simplicity Quilted Briefs, Large, (45”-58”) 72/CS

Covidien Surecare Underwear, Large, (44”-54”) 72/CS

T4524

First Quality Procare Briefs, X-Large, (59”-64”) 60/CS

First Quality Nu-Fit Briefs, X-Large, (59”-64”) 60/CS

First Quality Procare Underwear, X-Large, (58”-68”) 56/CS

First Quality Procare Plus Underwear, X-Large, (58”-68”) 100/CS

Covidien Simplicity Quilted Brief, X-Large, (59”-64”) 60/CS

Covidien Surecare Underwear, X-Large, (48”-66”) 56/CS

T4533

First Quality Prevail Briefs, Youth, (15”-22”) 96/CS

First Quality Prevail Extra Underwear, Youth/Small, (20”-34”) 88/CS

T4543

First Quality Procare Briefs, 2-XL, (62”-73”) 48/CS

First Quality Prevail Extra Underwear, 2-XL (68”-80”) 48/CS

 Covidien Surecare Underwear, 2-XL (60”-80”) 48/CSA4554ProCure Fluff Underpad, (23”-36”) 150/CS Covidien Tendersorb Fluff Underpad (23”-36”) 150/CS First Quality Procare Fluff Underpad, (23”-36”) 150/CST4529First Quality Cuties Baby Diapers – Newborn 169/CS First Quality Cuties Baby Diapers – Size 1 200/CS First Quality Cuties Baby Diapers – Size 2 168/CS First Quality Cuties Baby Diapers – Size 3 144/CS

T4530First Quality Cuties Baby Diapers – Size 4 124/CS First Quality Cuties Baby Diapers – Size 5 108/CS First Quality Cuties Baby Diapers – Size 6 92/CS First Quality Cuties Baby Diapers – Size 7 80/CS First Quality Cuties Boy Training Pants – Size 2 104/CS First Quality Cuties Boy Training Pants – Size 3 92/CS First Quality Cuties Boy Training Pants – Size 4 76/CS First Quality Cuties Girl Training Pants – Size 2 104/CS First Quality Cuties Girl Training Pants – Size 3 92/CS First Quality Cuties Girl Training Pants – Size 4 76/CST4535ProCure Premium Absorbent Liners 4” x 10” 200/CS ProCure Premium Absorbent Liners 7” x 17” 200/CS First Quality Prevail Moderate Pads 9.25” 180/CS First Quality Prevail Moderate Long Pads 11” 144/CS Covidien SureCare Bladder Control Pads 4” x 10” 132/CS Covidien SureCare Bladder Control Pads 4” x 14” 168/CST4537ProCure Reusable Bed Pad, Twill 30” x 36” 24/CS ProCure Reusable Bed Pad, Twill 34” x 36” 24/CS ProCure Reusable Bed Pad, Plaid 30” x 36” 24/CS ProCure Reusable Bed Pad, Plaid 34” x 36” 24/CST4539ProCure Products Reusable Diaper, Medium 60/CS ProCure Products Reusable Diaper, Large 60/CS ProCure Products Reusable Diaper, X-Large 60/CS ProCure Products Reusable Diaper, 2XLarge 60/CS ProCure Products Reusable Fitted Brief, Medium, 24/CS ProCure Products Reusable Fitted Brief, Large, 24/CS ProCure Products Reusable Fitted Brief, X-Large, 24/CS ProCure Products Reusable Fitted Brief, 2XLarge, 24/CST4540ProCure Products Reusable Chair Pad, Twill 60/CS ProCure Products Reusable Chair Pad, Plaid, 60/CSSlide17

NYS Medicaid Incontinence Supply Management Program Audit and Complaint Investigation

The Department will incorporate incontinence product minimum quality standards into its routine pre and post payment reviews and other routine audit processes

The Department will also investigate any complaints received from members or other parties concerning Medicaid providers dispensing products which do not meet the established minimum quality standards

August 2016Slide18

NYS Medicaid Incontinence Supply Management ProgramTwin Med Contact information

Telephone: 1-844-886-3369 (1-844-8TMEDNY)

FAX: 1-844-986-3369 (1-844-9TMEDNY)

Website: www.twinmedny.comSlide19

New York State Department of Health

Bureau of Medical Review

Office of Health Insurance Programs

Division of OHIP Operations and SystemsRiverview Center, 150 Broadway Menands, NY 12204Email: ohipmedpa@health.ny.govPhone: 1-800-342-3005