The ebb and flow of Medicaid reimbursement rates continued after the initial round of rate hikes following the enactment of OBRA89.
Despite this pullback in federal influence over reimbursement rate setting and limitations imposed on potential plaintiffs, a new round of pediatricoriented lawsuits ensued, based on the failure of the states to provide the EPSDT services mandated by OBRA89.
Plaintiffs' appeal contends that "substantial compliance" is the incorrect legal standard to be applied considering the definitive legislative intent of OBRA89.
Consequently, despite the unique claim to equal access afforded to children and pregnant women by OBRA89 and the supportive subsequent court decisions, the final chapter has not been written on this 16-year battle.
In the case of the OBRA89 procedures, however, the variations in price were driven mainly by changes in the prevailing charges.
The OBRA89 price reductions did not affect the fees of each medical procedure by the same amount and, in turn, not all practices were affected the same way.
One expects that the larger the dollar share of the OBRA89 procedures for a practice, the greater the impact of the fee reduction on the practice, making it more likely to increase volume.