Physicians Warn of Access Crisis for Nevada Medicaid Patients If Reimbursement Cuts Approved

By Sean Whaley
CARSON CITY – The state’s largest physician advocacy group has sent a letter to Gov. Brian Sandoval and all 63 lawmakers saying that 15 percent cuts in Medicaid reimbursements will make it even more difficult for some Nevadans to receive proper medical care.
Brian Callister, president of the Nevada State Medical Association (NSMA), said: “The proposed 15 percent cuts for most physician services added to the 40-plus percent cuts made since 2008 to obstetrical, pediatric, and anesthesiology services we believe has already resulted in significant access problems for pediatric Medicaid patients.
“Basically, Medicaid physician payment rates are based on 2002 Medicare physician fee rates,” he said. “We have repeatedly voiced our concern that physicians (and other providers) simply will not be able to afford the costs associated with providing care at the reduced rates and Medicaid patients face growing accessibility problems.”
The Nevada Department of Health and Human Services has proposed reimbursement reductions to a variety of health care provider categories as a way of cutting the Medicaid budget for the coming two years.
The Medicaid rate reductions recommended for a variety of medical providers in Sandoval’s initial budget proposal would save nearly $60 million in general funds over the two-year budget.
The Nevada Health Care Association, which represents the skilled nursing industry, has also objected to the reductions and suggested that some facilities could close with the Medicaid reimbursement cuts. The association is staging a rally to raise awareness of the Medicaid cuts at the Legislature on May 17.
The Sandoval administration recently proposed a restoration of some funding to skilled nursing facilities, reducing a $20 per Medicaid resident per day cut to $15.
Health care providers have questioned whether reimbursement reductions imposed purely for budgetary reasons are legal based on federal court rulings.
In the letter, the medical association noted the recent decision by the U.S. Supreme Court to review the impact on access to care by Medicaid patients when states significantly reduce payment for services.
The issue is a national one resulting from the recession and the growth in the uninsured population eligible for the state and federally funded Medicaid program. It has been reported that the Nevada program has grown by 3,000 people a month since the start of the recession.
The letter also points out also that the federal Department of Health and Human Services has just released new proposed rules that would make it harder for states to balance their budgets by reducing access to Medicaid covered services by reducing payment rates.
“Today, the U.S. Department of Health and Human Services issued a proposed regulation which requires states to conduct a review of patient experiences and demonstrate that Medicaid patients will have sufficient access to care before any proposals for provider payment rate reductions may be submitted,” Callister said in his letter. “The new federal rule would require Nevada to measure and document access to each covered benefit at least every five years.
“We believe that these new access assessments, which will take into account enrollee needs, the availability of care, and the utilization of services, could not justify Nevada’s current policy of maintaining the same payment rates for nine years, and the proposal to cut rates in the 10th and 11th years,” he said.
Legislative Democrats have proposed eliminating the cuts to physician Medicaid payments, but Sandoval has vowed to veto any measures requiring new fees or taxes to fund restorations to the two-year general fund budget.
“We urge the Legislature to eliminate these proposed cuts and to revise the Medicaid payment system to meet the needs of the rapidly growing population eligible and entitled to these covered services,” Callister said.
Otherwise these Nevadans may find that they have been promised benefits that they cannot access, he said.