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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.

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