Maine Medicaid Provider No Longer Paying for Procedures in ASCs

Bad news for Maine's 17 ambulatory surgical centers. MaineCare, the Medicaid provider for the state of Maine, has ceased paying for procedures performed in ASCs as of August 30, leaving providers and patients in the lurch. ASCs received notice August 17 that procedures would cease to be covered.

ASC procedures remain on the federal list of "optional" Medicaid services, and will remain there until or unless the state legislature modifies or rescinds that clause in the recently passed state budget package. Maine Gov. Paul LePage (R) proposed the cut in his initial supplemental budget in December 2011, and it was part of the budget bill that passed on May 15, says Andrew B. MacLean, JD, the deputy vice president of the Maine Medical Association.

"What they did, from the best we can gather, is look at the federal list of optional covered services for Medicaid, and cut all of them without a review," says John Wipfler, JD, MBA, president of the Maine Ambulatory Surgery Center Coalition. "The problem with that is no one looked at whether the procedures are going to go away, or move to another site of service. They simply made the argument it would save money — but these procedures are just going to go to the hospitals instead of the ASCs, which were being reimbursed 40 to 50% of what hospitals are for the same procedures."

"We're now meeting with and trying to get the commissioner's office on board to get ASC procedures reinstated as part of the next biannual budget," says Mr. Wipfler, also the CEO of OA Centers for Orthopedics in Portland, Maine. "If not, we'll work with an advocate to sponsor a bill during the next legislative session, in January. Either way, we're looking at this as an opportunity to educate about surgery centers."

Stephanie Wasek