WASHINGTON, D.C. – AAHomecare’s Payer Relations team is prepared for an active and impactful 2025, with efforts to protect or increase reimbursement rates continuing as a top priority.
At present, we expect to work with stakeholders in approximately 25 states on rate stability issues through legislation or regulatory efforts, including establishing rate floor protections in more than a dozen states. The effort is off to a strong start in Georgia, where we helped to get a rate floor included in the new Managed Care contract, which will go into effect after award protests are resolved.
The approaches and goals in the states vary, but the main avenues to bolster rates include:
- Advocating for across-the-board rate increases.
- Product-specific rate increases to ensure access to DME.
- Adding coverage for additional HCPCS categories.
- Preventing rate cuts.
Other priorities for 2025 outside of reimbursement rate advocacy include:
- Exempting certain DME products from sales taxes, with efforts planned in nine states.
- Improving access and coverage of NIV, CGM, CRT, enteral, incontinence, and other HME items where needed.
- Addressing continued TRICARE operational and contracting issues.
HME suppliers are increasingly frustrated by Medicare Advantage plans that limit access to care through improper denials or burdensome authorization processes. Making sure the plans comply with Medicare coverage policy and provide more transparency on their processes, benefits, and outcomes rounds out our priorities this year.
“We have an ambitious agenda for 2025,” says Laura Williard, senior vice president of payer relations. “There is a critical need to make sure that state policymakers understand the value of DME in the face of continuing cost-cutting pressures in annual budget processes.”
“Over the past eight-plus years, we’ve established strong relationships with healthcare officials and legislators, built on the persistence and credibility that leaders at our state and regional association bring to these efforts,” adds Williard. “As more DME suppliers get active and involved in state-level advocacy, our capability to bring home wins continues to grow.”
Adding Technology and Education to Your Payer Relations Arsenal
Another undertaking for 2025 is evaluating technology to support payer relations efforts. The AAHomecare team is excited by the prospect of adding a new digital resource to give suppliers insights to help negotiate contracts with payers. You can learn about the highly anticipated launch of our Payer Transparency Portal, powered by Medlyze, in a webinar set for Jan. 30 – see more details here (or scroll down to the event listing).
AAHomecare will also continue to build on the sessions we’ve developed for Medtrade to deliver more webinars focused on payer relations issues and best practices in 2025. When we work together and share our expertise on engaging different payer groups, the HME community gets stronger.
Click Here to see related Payer Relations content at Medtrade.
Click Here to see related Q&A with Laura Williard.