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Payer Relations Tools and Impact

Drastic reimbursement reductions under the bidding program and for non-bid area suppliers is decimating the HME community. The impact is now being felt with all payers. However, AAHomecare's team is employing a wide range of resources and working on multiple fronts to continue engagement with CMS, HHS, and the OMB including Medicare, Medicare Part C, Medicaid, and Duals Oversight Offices. The focus of the Association's payer relation's team is working towards relief on rural reimbursement rates that impact a broad range of payers. Advocating for fair, common-sense regulations that help put patients over paperwork, working with state and regional association leaders on Medicaid rates and other managed care payers, working with Medicaid plans and MCO plans to eliminate administrative costs for providers, and continuing to grow the resources to fight for HME interest in Washington and at the state level are a few of the ways we are making an impact. 

The strategy for Medicaid CURES has seen success. Laura Williard, vice president of payer relations, has participated in 23 state Medicaid meetings and completed ten utilization analysis as well as another seven alternate proposals with two of those being accepted and the others still pending. Thirteen states have been influenced to not make rate changes for 2018 and five states which have chosen to make rate changes have been influenced to only make changes to the 244 CURES HCPCS codes. 

As of October 2018, AAHomecare has developed the following CURES Medicaid Implementation Analysis:

States Already At Or Below Medicare Rates (6)
DC – Mississippi  –  Nevada [will be reducing to 2018 rates] –  Virginia  –  West Virginia - California
 
States Changing Rates to Medicare (11)
Vermont [all HCPCS] –  Montana [ll HCPCS but CRT] – Washington [all HCPCS but CRT] – Colorado [CURES codes only] –  Kentucky [Cures codes only] -Alabama [CURES codes only] – North Dakota [CURES codes only] – Connecticut [CURES codes only] – Maine [need information on which codes] – Massachusetts [need Information on which codes]  - Tennessee [Cures codes directive to MCO plans]
 
States Not Changing Rates (13)
Florida – Georgia – Hawaii – Michigan – Minnesota – North Carolina – Ohio – Pennsylvania – South Carolina – Iowa – Texas – Indiana – Rhode Island
States Accepting Proposal on Limited HCPCS/Multi Year Roll Out (2)
 Missouri - Wisconsin

States Currently Analyzing Fee Schedule and Data (10)
Oregon – Illinois – Kansas – New York – Oklahoma – New Hampshire – Wisconsin – Nebraska – South Dakota - Alaska

**Information based on meetings and/or discussions with state Medicaid plans or State Plan Amendments filed with CMS. Listing is subject to change as further analysis occurs. States not listed have not discussed their plans or filed State Plan Amendments.  

Below you will find links to resources for engaging payers on rate negotiations and other issues. 

Please contact Laura Williard, vice president of payer relations, via email for more information.

Medicaid Category         

Medicaid Cures

  1. Competitive Bidding Rates for Medicaid-Issue Brief February 2017
  2. Federal Match for DME Expenditures & Medicaid Payment Rates Analysis-Legal Opinion from Brown & Fortunato (January 2017)
  3. Cures HCPCS-2018  
  4. CMS State Medicaid Director Webinar Presentation 
  5. Cures Scorecard-Will have to be updated regularly
  6. AAH Issue Brief-DME Medicaid Cap Final (Legislative use)
  7. AAH Comments to CMS on RFI for Cures Medicaid
  8. CMS State Medicaid Director Webinar Presentation Cures Follow Up 2-26-18
  9. State Medicaid Director Letter 
  10. Cures State Presentations:

11. Medicaid Cures and MCO State Comments

Medicaid Face 2 Face

  1. Medicaid Face to Face Regulation 

Medicaid (Overall)

  1. CMS Information Bulletin to States for strategies to ensure access to DMEPOS 
  2. GAO report-Medicaid Managed Care July 2018 
  3. NAMD Bailit Health Value Based Purchasing in Medicaid

 
Managed Care/Medicare Advantage Category

  1. AAHomecare Shares Materials to Assist with Payer Engagement (Talking points prior to ESRD finalization) 
  2. BCBS MS Letter 
  3. Mississippi Meeting Packet-State Legislators, BCBS, Medicaid
  4. Cures legislation for Medicare Advantage/Medicare Based Plans
  5. Letter on Cures Legislation
  6. Medicare Regional Pricing Comparison
  7. Cost Study
  8. ATS Survey Highlights 
  9. Dobson DaVanzo Access Study
  10. Supplier Tracking
  11. AIM Sleep Management Proposed Guidelines by AAHomecare 
  12. History of Cuts to HME Reimbursement 
  13. Medicare Managed Care Appeal Manual 
  14. Medicare Managed Care Appeal Flowchart 
  15. UHC Letter-Invalid recoupments for contracted providers Fall 2018 
  16. Medicaid Managed Care Articles and Observations Around the Country
  17. Proposed Legislative Language for State Specific Initiatives


Tricare Category

  1.  Add one from Managed Care above
  2. Sample Provider Letter to Department of Defense-Mandated Tricare Reimbursements
  3. Tricare Contacts-Defense Health Agency 
  4. AAHomecare formal complaint on Humana Military to Defense Health Agency 

 
Sole Source Category

  1.  White Paper
Payer Relations A Year in Review 2018 Accomplishments